I WANT TO WELCOME EVERYONE AND CALL TO ORDER THE 51ST MEETING OF THE NIH ADVISORY COMMITTEE ON RESEARCH ON WOMEN'S HEALTH. MY NAME IS LIZ SPENCER. I AM PLEASED TO JOIN YOU AS THE NEW SENIOR ADVISOR TO THE DEPUTY DIRECTOR AND THE DIRECTOR OF THE DIVISION OF PROGRAM COORDINATION PLANNING AND STRATEGIC INITIATIVES AND TRANSITIONING EXECUTIVE SECRETARY OF THIS WONDERFUL COMMITTEE TO DR. NORSI, WHO IS THE ORWH ASSOCIATE DIRECTOR FOR SCIENCE POLICY, PLANNING AND ANALYSIS. THIS MEETING IS OPEN TOLL THE PUBLIC BY BROADCAST ON THE NIH VIDEOCAST NETWORK AND IS BEING RECORDED FOR OUR ARCHIVES AND FOR FUTURE ON DEMAND VIEWING BY THE PUBLIC. IF YOU'RE A MEMBER OF THE PUBLIC PER THE FEDERAL REGISTER NOTICE, YOU MAY SUBMIT YOUR QUESTIONS DREBTLY IN WRITING TO SAMIA, YOU'LL RECEIVE A RESPONSE DIRECTLY FROM HER. FOR ALL PARTICIPATING REMOTELY, THE ADVISORY COMMITTEE AND INVITED PARTICIPANTS ARE PARTICIPATING BY WEBEX. AND NOW FOR OUR MEMBERS, I'D LIKE TO REMIND YOU THAT YOU ALL ARE SPECIAL GOVERNMENT EMPLOYEES TODAY. AS MEMBERS OF THIS FEDERAL ADVISORY COMMITTEE, YOU ARE SPECIAL GOVERNMENT EMPLOYEE, WHICH MEANS YOU'RE SUBJECT TO THE SAME ETHICS RULES THAT APPLY TO GOVERNMENT EMPLOYEES. THESE RULES ARE DESCRIBED IN THE PAMPHLET ENTITLED STANDARDS OF ETHICAL CONDUCT FOR EMPLOYEES OF THE EXECUTIVE BRANCH. EACH OF YOU RECEIVED A COPY OF THIS DOCUMENT WHEN YOU WERE APPOINTED. AT EVERY MEETING -- I'M GOING TO PAUSE REAL QUICKLY. COULD SOMEONE SEND THE LINK TO DR. LANGER. AT EVERY MEETING WE LIKE TO REVIEW THE STEPS WE TAKE AND PROCESS WE FOLLOW TO IDENTIFY AND ADDRESS ANY CONFLICTS BETWEEN YOUR PUBLIC RESPONSIBILITIES AND YOUR PRIVATE INTERESTS. AS YOU KNOW FOR EVERY MEETING, YOU PROVIDE US WITH A GREAT DEAL OF INFORMATION ABOUT YOUR PROFESSIONAL, PERSONAL AND FINANCIAL INTERESTS. WE USE THIS INFORMATION AS THE FOUNDATION FOR ASCESSING WHETHER OR NOT YOU HAVE ANY REAL POTENTIAL OR APPARENT CONFLICTS OF INTEREST THAT COULD COMPROMISE YOUR ABILITY TO BE OBJECTIVE IN GIVING ADVICE DURING THE COMMITTEE MEETINGS. IF THE NEED FOR YOUR INDIVIDUAL SERVICES OUTWEIGHS THE POTENTIAL CONFLICTS OF INTEREST WE HAVE IDENTIFIED, WE WOULD ISSUE A WAIVER OR RECUSE YOU FROM A PARTICULAR PORTION OF THE MEETING. WE USUALLY WAVE WAIVE CONFLICTS OF INTEREST -- WILL NOT BE AFFECTED BY YOUR FINANCIAL INTERESTS. WE ALSO RELY A GREAT DEAL ON YOU. WE NEED YOU TO BE ATTENTIVE DURING THE MEETINGS TO THE POSSIBILITIES THAT AN ISSUE COULD ARISE THAT COULD AFFECT OR APPEAR TO AFFECT YOUR FINANCIAL INTERESTS WITH RESPECT TO A SPECIFIC PARTY OR MATTER. IF THIS HAPPENS, YOU WILL BE ABLE TO RECUSE YOURSELF FROM THAT PORTION OF THE MEETING. BEFORE THE INTRODUCTION, I'LL BRIEFLY REVIEW BEST PRACTICES FOR OUR WEBEX PARTICIPANTS. PLEASE MUTE YOUR MIC IF YOU'RE NOT SPEAKING. WHEN SPEAKING, PLEASE STATE YOUR NAME BEFORE MAKING ANY COMMENTS, MOTIONS OR REPRESENTATION RECOMMENDATIONS. TURN OFF YOUR VIDEO IF YOU'RE NOT SPEAKING TO PRESERVE THE INTERNET BANDWIDTH. IF YOU HAVE A QUESTION OR WOULD LIKE TO MAKE A COMMENT, PLEASE UTILIZE THE CHAT FEATURE. THE WEBEX CHAT WILL BE KEPT AS A PART OF THE OFFICIAL RECORD OF THE MEETING. THIS INCLUDES EVEN IF YOU HAVE A PRIVATE CHAT WITH SOMEONE ELSE IN THE MEETING THAT WILL ALSO BE RECORDED. WE WILL BE VOTING WITH THE WEBEX POLLING FUNCTION. DURING A VOTE, MULTIPLE CHOICE QUESTIONS WILL BE AVAILABLE WITH YES, NO, WE'LL DISPLAY ON THE RIGHT SIDE OF YOUR SCREEN. PLEASE SELECT YOUR RESPONSE AND CLICK SUBMIT. ADDITIONAL GUIDANCE IS AVAILABLE ON THE WEBEX PARTICIPANT GUIDE THAT YOU WERE PROVIDED PRIOR TO THIS MEETING. SO NOW ON TO THE MEETING. WE'LL GO FOR OUR -- GO THROUGH OUR ROSTER. WHEN YOU HEAR YOUR NAME, PLEASE UNMUTE YOUR MIC, INTRODUCE YOURSELF BY NAME, AND THE INSTITUTION THAT YOU REPRESENT. SO FOR OUR MEETING TODAY, DR. BREWSTER. DR. FILLINGIM. >> HI, ROGER FILLINGIM, UNIVERSITY OF FLORIDA. >> DR. GELLER? >> GOOD MORNING, ALL. STACIE GELLER, UNIVERSITY OF ILLINOIS. >> THANK YOU. DR. KLEIN? >> HI. PROFESSOR OF MICROBIOLOGY AND IMMUNOLOGY AT THE JOHN HOPKINS SCHOOL OF PUBLIC HEALTH. >> DR. LANGER IS STILL HAVING DIFFICULTY LOGGING IN. IF YOU COULD HELP HER. AND WE'LL SKIP TO DR. MCGREGOR. >> DR. LANGER IS ON. >> DR. LANGER. WE CAN'T HEAR YOU. WE'LL COME BACK TO DR. LANGER IF SOMEONE COULD REACH OUT AND HELP HER. DR. MCGREGOR? >> HI, ALISON MCGREGOR. BROWN UNIVERSITY. >> ANA, IS THAT YOU? YOU'RE BREAKING UP. WE'LL SEE IF SOMEONE CAN REACH OUT AND HELP DR. LANGER. DR. REAGANSTEINER. >> HI, JUDY REAGANSTEINER, UNIVERSITY OF COLORADO SCHOOL OF MEDICINE. >> THANK YOU. DR. RIOS? >> DR. RIOS HERE. AND DR. ROBINSON? >> GOOD MORNING, MICHELLE ROBINSON, UNIVERSITY OF ALABAMA AT BIRMINGHAM. >> WELCOME. DR. SHAH. >> GOOD MORNING, NEIL SHAH FROM HARVARD MEDICAL SCHOOL. >> WELCOME. DR. WOOD? DR. PALLER? DR. PALLER, I SAW YOU ON, BUT IT LOOKS LIKE YOU'RE MUTED. AMY? >> OKAY, I'M SORRY. I DIDN'T REALIZE I HAD TO MUTE ON THE COMPUTER IN ORDER TO BE HEARD ON THE PHONE. HI. AMY PALLER FROM NORTHWESTERN UNIVERSITY, CHICAGO, ILLINOIS. >> WELCOME. AND DR. LANGER, SHOULD WE TRY AGAIN? I SEE YOU ON THE VIDEO. >> YEAH, YEAH, CAN YOU HEAR ME NOW? >> FANTASTIC. >> SORRY, I HAD SOME TECHNICAL DIFFICULTIES. HI. I'M ANA LANGER FROM THE HARVARD SCHOOL OF PUBLIC HEALTH. HAPPY TO BE HERE TODAY. >> WELCOME. MICHAEL OR SARAH, I GOT A NOTE DR. STEFANICK IS HAVING SOME DIFFICULTY GETTING IN. PERHAPS YOU'VE ADDRESSED IT ALREADY. DR. JAGSI. >> HI, UNIVERSITY OF MICHIGAN. >> DR. SIDOSKI? >> HI, MCGEE WOMEN'S RESEARCH INSTITUTE AT THE UNIVERSITY OF PITTSBURGH. >> WELCOME. AND DR. TEMPLETON WILL BE JOINING US A BIT LATER AND WE WILL LOOK FOR HER TO JOIN US. I'D LIKE TO TAKE A MOMENT NOW TO RECOGNIZE A NUMBER OF OUR RETIRING ADVISORY COMMITTEE MEMBERS. AND DR. WENDY BREWSTER FROM THE UNIVERSITY OF NORTH CAROLINA, DR. LOUISE MCCULLOUGH, UNIVERSITY OF TEXAS, DR. AMY PALLER FROM NORTHWESTERN AND DR. SUSAN WOO D FROM GEORGE WASHINGTON UNIVERSITY. EACH OF YOU HAS CONTRIBUTED SIGNIFICANTLY OVER THE PAST FEW YEARS TO ORWH, AND WE WILL ALL MISS YOU. I ONLY WISH THAT WE WERE ALL TOGETHER IN PERSON, THAT WE COULD THANK YOU PROPERLY. SO WE HAVE ONE MORE MINOR HOUSEKEEPING ITEM TO ATTEND TO AND THAT IS THE MINUTES. WE POSTED THE MEETING FROM OUR LAST MEETING APRIL 21ST ON THE ORWH WEBSITE AND A LINK WAS SENT TO YOU FOR YOUR REFERENCE. IS THERE A MOTION ON THE TABLE TO ACCEPT THE APRIL 21ST, 2020 MINUTES AS WRITTEN? DO I SEE A -- >> SO MOVED. >> THANK YOU, AND WHO WAS THAT? >> THAT WAS AMY. >> THANK YOU, AMY. SO DR. PALLER HAS SUBMITTED A MOTION. DO I HEAR A SECOND? >> SECOND. >> THANK YOU. AND WHO WAS THAT? >> DR. RIOS. >> THANK YOU, DR. RIOS. THANK YOU BOTH. A POLL HAS BEEN OPENED FOR YOU TO RESPOND. IF YOU ARE IN FAVOR OF ACCEPTING THE MINUTES, PLEASE ENTER YOUR RESPONSES NOW, FOR INFAVOR, OPPOSE OR ABSTAIN. YOU'LL HAVE 30 SECONDS TO RESPOND AND SUBMIT YOUR RESPONSE. >> WHERE DO WE RESPOND? >> THERE SHOULD AB POLL ON SHOULD BE A PO LL ON THE RIGHT-HAND SIDE OF YOUR SCREEN. >> OKAY. IF YOU WEREN'T ABLE TO RESPOND, IF YOU COULD JUST ENTER YOUR RESPONSE IN THE CHAT AND WE CAN RECORD YOUR VOTE IN THAT MANNER. SO WE'LL BE CLOSING THE POLL AT THIS TIME. NOW IT'S MY HONOR TO INTRODUCE THE CHAIR OF THIS COMMITTEE AND THE DIRECTOR OF ORWH, DR. JANINE CLAYTON. >> GOOD MORNING, EVERYONE. ARE YOU ABLE TO SEE ME? >> NO, WE DON'T SEE YOU: . >> NOW IS IT OKAY? >> NOW IT'S OKAY. >> OKAY, GREAT. WONDERFUL. GOOD MORNING, EVERYBODY. I'M DELIGHTED TO BE HERE AND EXCITED TO BE ABLE TO SHARE INFORMATION WITH YOU ABOUT ALL THE HARD WORK THAT ORWH AND NIH HAS BEEN DOING TO ADVANCE SCIENCE FOR THE HEALTH OF WOMEN. THANK YOU SO MUCH FOR BEING HERE THIS MORNING. IT'S A PARTICULARLY CHALLENGING TIME ALL AROUND, IT FEELS LIKE THE WORLD HAS BEEN TURNED UPSIDE-DOWN, AND WOMEN'S HEALTH IS MORE IMPORTANT THAN EVER. BEFORE WE GET STARTED, I DO WANT TO ACKNOWLEDGE THAT MANY, MANY INDIVIDUALS, WE'VE LOST THIS PAST YEAR. THERE ARE TOO MANY TO COUNT, AND ON TOP OF THAT, IN THE CONTEXT OF LOSING HUNDREDS AND THOUSANDS OF AMERICANS TO COVID-19, IT'S REALLY IMPORTANT THAT WE ALL ACKNOWLEDGE THAT AND AS WE MOVE FORWARD, THAT IT ENERGIZES US TO WORK EVEN HARDER. SO I KNOW THAT YOU JOIN ME IN RECOGNIZING THOSE LOSSES. MICHAEL, IF YOU COULD START MY SLIDES, THAT WOULD BE GREAT. THANK YOU. SO EACH OF THESE MEETINGS, I SHARE WITH YOU THE DIRECTOR'S REPORT, AND WE CALL IT THE DIRECTOR'S REPORT, BUT REALLY IT IS THE ORWH REPORT. IT'S MY OPPORTUNITY AND MY PRIVILEGE TO BE ABLE TO SHARE ON BEHALF OF THE OFFICE AND ALL THE INDIVIDUALS AT TEAM ORWH THAT HAVE WORKED SO HARD TO SHARE THIS INFORMATION WITH YOU, AND THIS YEAR IS ESPECIALLY EXCITING BECAUSE IT IS OUR 30TH ANNIVERSARY. I THOUGHT I WOULD SHARE THIS PICTURE WHICH INCLUDES DR. KIRS TEEN IN THE FRONT IN HER RED BLAZER AND HER PIN TO HER LEFT AND HER PLAID BLAZER AND SO MANY OF THE AMAZING LEADERS THAT WERE HERE WITH US IN THE VERY BEGINNING. THROUGHOUT MY PRESENTATION, I'M JUST GOING TO INTERRUPT AT A FEW DIFFERENT LOCATIONS TO SHARE SOME MOMENTS FROM HISTORY AND SOME REMARKS FROM OUR AMAZING COLLEAGUES WHO WERE SO IMPORTANT TO GETTING ORWH STARTED. AND ONE OF OF THOSE IS AMBASSADOR CONNIE MORELLA, ONE OF THE ORIGINAL FOURSOME. SHE CELEBRATED US IN HER RECENT BLOG POST WHERE SHE STATED: AS WE CELEBRATE THE 30TH ANNIVERSARY OF THE NIH OFFICE OF RESEARCH ON WOMEN'S HEALTH, THE GIFT THAT KEEPS ON GIVING, WE ACKNOWLEDGE THAT WITH ALL IT'S ACCOMPLISHED, WE HAVEN'T FINISHED. WE WILL MONITOR THE PROGRESS AND POLICIES, RESEARCH, PROGRAMS AND CAREER DEVELOPMENT. NO LONGER ARE WE CONSIDERED "LITTLE MEN," RATHER, WE ARE PROUD, HEALTHY WOMEN. ONWARD AND UPWARD! SO THANK YOU, AMBASSADOR MORELLA, FOR YOUR WORDS OF ENCOURAGEMENT AND WE KNOW THAT YOU WILL BE CHECKING US OUT ALWAYS GOING FORWARD. AND IT'S YOU, THE ADVISORY COMMITTEE FOR RESEARCH ON WOMEN'S HEALTH, AND THE PREVIOUS MEMBERS OF THE ACRWH THAT HAVE BEEN SO IMPORTANT IN ADVISING ORWH AND NIH OVER THE YEARS IN TERMS OF HOW WE SHOULD BE ADDRESSING THE HEALTH OF WOMEN, WHAT WE SHOULD BE PRIORITIZING, AND YOU'VE NEVER LET US FORGET CONCERNS ABOUT THE HEALTH OF WOMEN AS WELL AS WOMEN IN THE BIOMEDICAL RESEARCH WORKFORCE. AND VERY RECENTLY, SEVERAL OF OUR ADVISORY COMMITTEE MEMBERS AND FORMER MEMBERS CAME TOGETHER TO PUBLISH THIS AMAZING PIECE IN THE LANCET THAT'S ENTITLED "SEX AND GENDER, NOT FIRES OF HEALTH, MODIFIER S OF HEALTH, DISEASE AND MEDICINE" AND REVIEWS THIS VERY IMPORTANT TOPIC AT A VERY HIGH LEVEL AND VERY COMPREHENSIVE MANNER. SO IF YOU HAVEN'T SEEN IT, I REEF YOU TO THIS LANCET PIECE CO-WRITTEN BY MANY OF OUR FORMER ADVISERS. AND THANK YOU TO ALL OF OUR ACRWH MEMBERS FOR ALL THE WORK YOU'VE DONE. HERE'S FORMER SENATOR BARBARA MIKULSKI FROM THE GREAT STATE OF MARYLAND, AND SHE SAYS SHE COULD NOT BE PROUDER OF THE OFFICE OF RESEARCH ON WOMEN'S HET AND ALL WOMEN'S HE ALTH AND ALL IT'S DONE FOR WOMEN'S HEALTH, AND I'M HONORED TO BE PART OF ITS FOUNDATIONAL HISTORY. SENATOR MIKULSKI, WE MISS AND WE ARE PRIVILEGED TO WORK ON THIS IN THIS OFFICE AND TO SUPPORT SCIENCE FOR THE HEALTH OF WOMEN. NEXT SECTION IS A COUPLE OF NEW NEW ITEMS IN SCIENCE, JUST REALLY HIGH LEVEL. AND I WAS REALLY EXCITED TO SEE THIS PIECE IN "SCIENCE." IT'S WHAT I CALL AN EXAMPLE OF SABV, SEX AS A BIOLOGICAL VARIABLE, IN ACTION. AND IT HIGHLIGHTS THAT SEX DIFFERENCES IN GENE EXPRESSION ARE UBIQUITOUS. ON THE LEFT YOU CAN SEE A MALE AND FEMALE FORM. THIS IS FROM A GTEX COMMON FUND PROGRAM WHERE TISSUES WERE TAKEN FROM -- SAMPLES WERE TAKEN FROM # 44 TISSUES ACROSS THE HUMAN BODY AND YOU CAN SEE THE TISSUES HIGHLIGHTED IN COLOR THERE. THOSE COLORS CORRESPOND TO THE MIDDLE HISTOGRAM WHERE YOU CAN SEE THE NUMBER OF SEX BIASED GENES BY TISSUE. 13,295 GENES ACROSS THESE 44 TISSUES HAD SEX EFFECTS, AND YOU CAN SEE THAT IN THAT HISTOGRAM IN THE MIDDLE, AND THEN YOU CAN SEE TO THE RIGHT THAT THERE WERE 37% OF ALL OF THOSE GENES EXHIBITED SEX BIAS EXPRESSION IN AT LEAST ONE TISSUE, AND YOU CAN SEE THE BODILY FUNCTION, THE SYSTEMIC FUNCTION FOR WHICH THOSE SEX BIASED REGULATION OF GENE EXPRESSION WERE EVIDENT, WHETHER IT'S BALDING PATTERN OR BREAST CANCER, EACH OF WHICH YOU'RE NOT SURPRISED BY, BUT YOU MIGHT BE SURPRISED THAT BIRTH WEIGHT OF A MALE AND FEMALE INFANT ARE ALSO SEX BIASED BUT IN DIFFERENT GENES. SO THAT'S A REALLY INTERESTING FINDING, AND IT'S ALSO INCREDIBLY IMPORTANT THAT LARGE PROGRAMS, DISEASE AGNOSTIC BASIC SCIENCE FUNDAMENTAL PROGRAMS LIKE GTEX HAVE INCORPORATED AN SABV PERSPECTIVE IN ALL THAT THEY DO AS WE MOVE FORWARD. THAT'S A REALLY GREAT EXAMPLE OF SABV IN ACTION. SO AS I BEGAN OUR REMARKS TODAY, IT'S REALLY IMPOSSIBLE TO DO ANYTHING THAT WE'RE DOING WITHOUT RECOGNIZING AND ACKNOWLEDGING THE EFFECT OF THE COVID-19 PANDEMIC ON WHAT WE'RE DOING. IT IS CHANGING ACADEMIA, IT'S CHANGING RESEARCH, AND IT'S CHANGING THE WORKPLACE. I WOULD SAY THAT IT'S LAID BARE GENDER INEQUITIES ACROSS SOCIETY GENERALLY BUT WOMEN IN ACADEMIA, ESPECIALLY WOMAN OF COLOR, FACE MORE SEVERE VERSIONS OF LONG-STANDING GENDER GAPS THAT HAVE ALREADY CAUSED UNIVERSITIES TO LOSE WOMEN FACULTY. INTERRUPTION TO A RESEARCH CAREER CAN CERTAINLY HAMPER PROGRESS, PROMOTION AND TENURE, THE ABILITY TO MOVE FORWARD IN CAREER DEVELOPMENT. WE'RE SEEING A DECREASE IN WOMEN FIRST AUTHORSHIP, SENIOR AUTHOR SLIP, WE'RE SEEING A AUTHORSHIP, WE'RE SEEING A GAP IN PUBLICATION RATES AS WELL, AND THAT'S ONE VERY TANGIBLE EXAMPLE OF AN OUTCOME THAT IS SO FAR EVIDENT FROM THE COVID-19 PANDEMIC. WE'RE PARTICULARLY CONCERNED ABOUT THE DEVASTATING IMPACT THAT THE PANDEMIC MAY HAVE ON EARLY CAREER INVESTIGATORS THAT HAVE BEEN SUPPORTED OR WERE AT THE CUSP OF STARTING A SCIENCE CAREER, AND WE'RE VERY CONCERNED AS WELL THAT WOMEN'S DEPARTURES WILL AFFECT THE DIRECTION OF RESEARCH IN FUNDAMENTAL WAYS AND FOR YEARS. FOR EXAMPLE, WE KNOW THAT HAVING MORE FEMALE AUTHORS ON A PAPER IS ASSOCIATED WITH THE LIKELIHOOD THAT THE PAPER WILL ADDRESS SEX AS A BIOLOGICAL VARIABLE, AND WOMEN AND MEN MAY ASK DIFFERENT RESEARCH QUESTIONS SO CERTAIN TOPICS MAY BE ADDRESSED MORE DEPENDING ON THE GENDER DIVERSITY OF THE WORKFORCE. INDEED, THIS McKENZIE REPORT HIGHLIGHT THAT THEY ARE PREDICTING THAT 1 IN 3 WOMEN WILL LEAVE THE WORKFORCE, THIS IS BROADLY, NOT JUST SCIENCE. AND SO THAT IS SOMETHING WE ARE PARTICULARLY PAYING ATTENTION TO AS WE MOVE FORWARD. AND I WANT TO SHARE ONE OF OUR BIRCH PIs THAT'S AT THE FOREFRONT OF THE COVID-19 RESPONSE, DR. KAREN FREUND, PROFESSOR OF MEDICINE AT TUFTS, AND SHE'S LEADING A CTSA THAT'S FOCUSED ON BREAST CANCER DISPARITIES, IN FACT, A VERY COMMUNITY-BASED STRATEGY AT THE CTSA, AND SHE'S ALSO LEADING TUFTS MEDICAL CENTER COVID-19 RESPONSE. SO ORWH GRANTEES, FORMER GRANTEES ARE AT THE FOREFRONT IN MANY, MANY WAYS AND I'M JUST HIGHLIGHTING ONE EXAMPLE HERE. FORMER SENATOR SNOW HIGHLIGHTED A WATERSHED MOMENT THAT BROUGHT GENDER EQUITY TO MEDICAL SCIENCE. SO WHAT'S NEW AT NIH AND ORWH REGARDING WOMEN'S HEALTH? THERE ARE THREE NEW WOMEN NIH AND INSTITUTE CENTER DIRECTORS THAT I WANT TO INTRODUCE YOU TO. THAT BRINGS OUR TOTAL TO 10 SO WE'RE BACK TO THE POWER OF 10. DR. LINDSEY CRISWELL. DR. RENA DSOUZA, AND DR. SHANNON ZENK WHO'S JOINED US HERE AS THE DIRECTOR OF THE NATIONAL INSTITUTE OF NURSING RESEARCH. DRS. MICHAEL CHIANG AND RICK WOYCHIK OF NEI AND NIEHS RESPECTIVELY. AT THE OUTSET, YOU HEARD FROM MS. LIZ SPENCER ABOUT HER NEW POSITION AS SENIOR ADVISOR FOR WORKFORCE DEVELOPMENT AND DPCPSI, AND I WANT TO ACKNOWLEDGE AND THANK LIZ FOR ALL OF HER WORK AS THE ORWH DEPUTY DIRECTOR FOR MANY YEARS, AND FOR HER SERVICE TO THIS COMMITTEE AS EXECUTIVE SECRETARY LEADING UP TO THIS MEETING. AND I'D LIKE TO WELCOME AS YOU HEARD DR. SAMIA NOURSI, ASSOCIATE DIRECTOR GUY SCIENCE POLICY, PLANNING AND ANALYSIS, WHO HAS BEEN APPOINTED ORWH AND ACRWH EXECUTIVE SECRETARY. A COUPLE OTHER ISSUES I WANT TO BRING TO YOU, NIH CONDUCTED A WORKPLACE CLIMATE SURVEY ADDRESSING HARASSMENT BROADLY. LED BY THE NIH OFFICE OF SCIENTIFIC WORKFORCE DIVERSITY. OVER 36,000 WERE SURVEYED WITH A 44% RESPONSE RATE, WHERE INDIVIDUALS WERE ASKED ABOUT THEIR EXPERIENCES RELATED TO HARASSMENT FOR THE PREVIOUS 12 MONTH. 1 IN 5 EXPERIENCED SEXUAL HARASSMENT, WHICH INCLUDES GENDER HARASSMENT, HALF EXPERIENCED INCIVILITY AND 10% EXPERIENCED BULLYING. IF YOU LOOK AT THAT AT A LITTLE GRANULAR LEVEL, YOU CAN SEE THE PERCENTAGES OF EACH VULNERABLE GROUP THAT EXPERIENCED SEXUAL HARASSMENT IN THE PAST 12 MONTHS. THE GENDER IDENTITIES, THE STATUS AS TRAINEES, WHO HAVE A HIGHER RISK, THE YOUNGER INDIVIDUALS 18 TO 24-YEAR-OLDS, AND THOSE WERE DISABILITIES, AS WELL AS THE PROPORTION THAT WERE WOMEN. THIS DATA IS AVAILABLE AT THE NIH WEBSITE LISTED ON THE SLIDE BELOW. HERE YOU CAN SEE AMONG THE RESPONDENTS EXPERIENCING SEXUAL HARASSMENT IN THE PAST 12 MONTHS. 85% OF THEM ALSO EXPERIENCED ANY INCIVILITY. AND THEN OF THOSE INDIVIDUALS WHO EXPERIENCE SEXUAL HARASSMENT, IT'S NOT SURPRISING TO SEE THAT THERE WERE LOWER SCORES FOR JOB SATISFACTION. SO THIS IS HAVING A PROFOUND IMPACT AMONG THE WORKFORCE BROADLY IN THE UNITED STATES, AND THE NIH HAS BEEN WILLING TO LOOK AT OURSELVES AND EXAMINE OUR DATA SO THAT WE CAN FOCUS ON ADDRESSING THESE ISSUES AND SOLVING THESE PROBLEMS. I ALSO WANT TO SHARE WITH YOU SOME NEW PROGRAMS THAT WE HAVE BEEN DEVELOPING WOMEN HAVE EXPRESSED DURING CRITICAL LIFE EVENTS. HERE YOU CAN SEE GOING FROM THE LEFT TO THE RIGHT THE CAREER PROGRESSION FROM DEGREE ATTAINMENT WHERE WE DO SEE PARITY BETWEEN WOMEN AND MEN AND WOMEN IN DARK BLUE AND MEN IN TURQUOISE. WHEN YOU MOVE FROM THE DEGREE TO POSTDOC RESIDENCY FELLOW POSITION, WE SEE A SLIGHT DECREASE BUT STILL NEAR PARITY, BUT WHEN YOU MOVE TO THE TENURE TRACK POSITION AS WE GO INTO OUR RESEARCH CAREER, WE SEE A REDUCTION IN THE PROPORTION OF WOMEN AND AT THE FULL PROFESSOR LEVEL, WE SEE A STARK REDUCTION TO THE 20% RANGE. WE KNOW THAT DESPITE THE FACT THAT WOMEN HAVE BEEN RECEIVING 50% OF LIFE SCIENCES PH.D.s FOR OVER 20 YEARS, WOMEN ARE NOT REACHING PARITY IN THE LEAD ARE LEADERSHIP POSITIONS, AND THIS IS NOT SIMPLY A PIPELINE ISSUE. SO THAT WE KNOW THERE IS A BIG DROPOFF BETWEEN THE POSTDOC OR FELLOWSHIP AND THE TENURE TRACK POSITION, SO WE HAVE DEVELOPED CONTINUITY SUPPLEMENTS DESIGNED TO SUPPORT GRANTEES THAT ARE K AWARDEES THAT EXPERIENCE A QUALIFYING LIFE EVENT DURING THAT PERIOD. WE KNOW ANOTHER TRANSITION POINT IS FROM THAT FIRST R01 TO A RENEWAL SO THE SECOND SUPPORTS RPG AWARDEES THAT HAVE FIRST R01 EQUIVALENTS AND THEY'RE APPROACHING THEIR RENEWAL. THESE SUPPLEMENTS SUPPORT INDIVIDUALS TO RETAIN THEM IN THEIR RESEARCH BIOMEDICAL ENTERPRISE AND I'M REALLY EXCITED TO SHARE THESE TWO NEW OPPORTUNITIES WITH YOU AND ASK THAT YOU SHARE THIS AVAILABILITY OF THESE SUPPLEMENTS WITH YOUR COLLEAGUES. NEXT SLIDE, PLEASE. A CONTINUITY SUPPLEMENTS I JUST MENTIONED WILL BE SEVERAL OF FOUR CONCEPTS THAT WERE DEVELOPED OUT OF THE NIH WORKING GROUP FOR WOMEN IN BIOMEDICAL CAREERS. DR. COLLINS CHALLENGED THAT WORKING GROUP TO COME UP WITH NEW STRATEGIES AND THOSE ARE SOME EXAMPLE, I'M GOING TO MENTION ANOTHER ONE IN JUST A MOMENT. THESE EFFORTS ALIGN WITH THE RECENT NATIONAL ACADEMY'S CONSENSUS STUDY AND REPORT, AS WELL AS THE NIH ACD WORKING GROUP ON CHANGING THE CULTURE TO END SEXUAL HARASSMENT RECOMMENDATIONS THAT THE NIH DIRECTOR HAS ACCEPTED AND IS MOVING FORWARD ON, IN ADDITION TO OTHER NIH POLICY CHANGES. AND I WANT TO QUOTE DR. COLLINS HERE, WHERE HE SAYS THAT SOME WOULD SAY PROGRESS IS BEING MADE, AND WE NEED TO LET CURRENT TRENDS TAKE CARE OF THIS INEQUITY. BUT THAT WOULD TAKE DECADES, AND AS DR. COLLINS SAYS, THAT IS JUST NOT SUFFICIENT. NIH IS DETERMINED TO DO OUR PART TO PRODUCE A DISCONTINUITY IN THOSE CURVES OF REPRESENTATION OF WOMEN AND OTHER UNDERREPRESENTED GROUPS IN SCIENCE. SO WITH THAT, I'M EXCITED TO SHARE WITH YOU THE NIH CHALLENGE PRIZE TO RECOGNIZE AND DISSEMINATE TRANSFORMATIVE INSTITUTIONAL APPROACHES. THE CHALLENGE PRIZE HAS AS ITS GOALS TO RECOGNIZE STRUCTURE, SYSTEMS, PROJECTS AND PROCESSES THAT HAVE ENHANCED GENDER DIVERSITY WITHIN AN INSTITUTION. OUR PLATFORM FOR SUBMISSION IS LIVE, AND AN ANNOUNCEMENT IS ON THE CHALLENGE.GOV WEBSITE. YOU CAN SEE THE WEBSITE FOR THE CHALLENGE PRIZE HERE, THE NIH PRIZE FOR ENHANCING FACULTY GENDER DIVERSITY. THE PRIZE IS CONSTITUTED BY $50,000 TO UP TO 10 INSTITUTIONS WITH POSSIBLE HONORABLE MENTIONS, AND THE PRIZE COMES WITH AN OPPORTUNITY TO PRESENT AT AN ORWH NIH SYMPOSIUM. THE DEADLINE FOR APPLICATIONS IS APRIL 16TH, 2021. AGAIN, WE WOULD APPRECIATE YOU GETTING THE WORD OUT TO AS MANY DIFFERENT KINDS OF INSTITUTIONS AS POSSIBLE SO THAT WE CAN AWARD ROBUST EFFORTS AND GENDER DIVERSITY AND TRY TO SHARE SOME OF THOSE LESSONS LEARNED ACROSS THE BOARD THROUGH TOOL KITS AND THE SYMPOSIUM AND OTHER EFFORTS. IT'S MY PRIVILEGE TO ALSO SHARE NEWS ABOUT OUR E-LEARNING EFFORTS, AND WE HAVE A VARIETY OF NEW ONLINE COURSES THAT ARE DESIGNED TO EDUCATE THE BIOMEDICAL RESEARCH COMMUNITY ON SEX AND GENDER AND ITS IMPORTANCE IN HUMAN HEALTH AND IN RESEARCH. WE PARTNER WITH THE U.S. FOOD AND DRUG ADMINISTRATION'S OFFICE OF WOMEN'S HEALTH IN OUR BENCH TO BEDSIDE COURSE CALLED INTEGRATING SEX AND GENDER TO IMPROVE HUMAN HEALTH, AND WE NOW HAVE IMMUNOLOGY MODULE, CARDIOVASCULAR DISEASE MODULE, PULMONARY DISEASE, NEUROLOGY. THE NEWEST IS OUR ENDOCRINOLOGY MODULE AND A MENTAL HEALTH MODULE IS COMING VERY, VERY SOON. I'M PLEASED TO SHARE WITH YOU THAT WE'VE HAD OVER 4,000 VISITORS TO THIS WEBSITE SINCE MARCH AND MORE THAN 500 UNIQUE VISITORS JUST IN AUGUST, AND SO FAR THE IMMUNOLOGY MODULE, WHICH WAS THE FIRST MODULE, IS THE MOST POPULAR. AND DR. SABRA KLEIN WAS ONE OF OUR AUTHORS ON THE IMMUNOLOGY MODULE. IN SEPTEMBER, WE HOSTED A WEBINAR TO INTRODUCE THE NEUROLOGY MODULE, AND FORMER ACRWH MEMBER AND FACULTY FOR THE COURSE, DR. FARIDA SOHRABJI, LED THAT WEBINAR. SHE URGED THE CONSIDERING OF SEX AND GENDER IN NEUROLOGICAL HEALTH AND THREE CONDITIONS COVERED IN THE E-LEARNING MODULE. : ISCHEMIC STROKE, PARKINSON'S DISEASE AND EP LIP EPILEPSY. WE HAD NEARLY 377 PARTICIPANTS PARTICIPATE. I'M ALSO EXCITED TO SHARE WITH YOU THAT RELEASE OF THE SEX AS A BUY LODGE VARIABLE PRIMER, A COLLABORATION BETWEEN ORWH IS IMMINENT AND YOU SHOULD STAY TUNED IN THE COMING MONTHS TO SEE A LITTLE PEEK OF THAT. WE'LL ALSO HAVE AN INTRODUCTORY COURSE TO THE SCIENTIFIC BASIS OF SEX AND GENDER-RELATED DIFFERENCES THAT WILL BE AVAILABLE ON OUR WEBSITE AS WELL. THE CENTERS OF EXCELLENCE AND PAIN EDUCATION PROGRAM IS AN ONLINE RESOURCE FOR THE DEVELOPMENT, EVALUATION AND DISTRIBUTION PAIN MANAGEMENT CURRICULUM MATERIAL FOR MEDICAL, DENTAL, NURSING, PHARMACY AND OTHER SCHOOLS. IT INCLUDES CASE-BASED LEARNING AND ORWH HAS BEEN PLEASED TO SUPPORT THE COEPE'S ALONG WITH THE PAIN CONSORTIUM FOR MANY, MANY YEARS. I'M DELIGHTED TO SHARE WITH YOU THAT THERE'S A NEW WEBSITE FOR THE COEPES AVAILABLE, AND I COMMEND YOU TO TAKE A LOOK AT THAT WEBSITE AND SEE THE MANY CASES AND CURRICULA AVAILABLE. WE KNOW THAT PAIN CONDITIONS AFFECT WOMEN DIFFERENTLY THAN MEN AND MORE WOMEN THAN MEN, SO PLEASE TAKE A LOOK AT THAT AND I CONGRATULATE THE PAIN CONSORTIUM ON ITS CONTINUED COMMITMENT TO BOTH PAIN RESEARCH ADDRESSING SEX AND GENDER AND EDUCATION AT AN INTERPROFESSIONAL LEVEL. THE DEPARTMENT DEPARTMENT OF HEALTH AND HUMAN SERVICES HAS IDENTIFIED HYPERTENSION AS ONE OF ITS FOCUS AREAS FOR THE HEALTH OF WOMEN AND FOR MATERNAL HEALTH. WE RECENTLY ACKNOWLEDGED NATIONAL WOMEN'S BLOOD PRESSURE AWARENESS WEEK WITH AN EFFORT TO TO INCREASE BLOOD PRESSURE CONTROL ESPECIALLY FOR WOMEN OF REPRODUCTIVE AGE, AND WE KNOW THAT PRE-PREGNANCY HEALTH OF WOMEN HAS DECLINED AND THAT CONTROLLING BLOOD PRESSURE AND HYPERTENSION MANAGEMENT IS ONE OF THE WAYS THAT WE CAN ADDRESS THE HEALTH OF WOMEN PRE-PREGNANCY AND THE HEALTH OF WOMEN IN PRE-PRODUCTIVE AGE. HEALTHY BEHAVIORS AND INCORPORATING THOSE INTO DAILY LIFE AND ENCOURAGING ALL WOMEN TO REGULARLY TAKE, TRACK AND SHARE THEIR BLOOD PRESSURE NUMBERS WITH THEIR PROVIDERS WAS ONE OF THE STRATEGIES THAT WAS INCLUDED IN THE WOMEN'S BLOOD PRESSURE AWARENESS WEEK. THE DEPARTMENT HAS ALWAYS LAUNCHED A MILLION HEARTS HYPERTENSION CONTROL CHALLENGE, SO I COMMEND YOU TO TAKE A LOOK AT THE WEBSITE THERE TO BE ABLE TO FIND OUT WHAT THEY'RE LOOKING FOR IN THEIR HYPERTENSION CONTROL CHALLENGE, AND SECRETARY AZAR HAS ALSO ACKNOWLEDGED RECEIPT OF THE TASK FORCE FOR PREGNANT AND LACTATING WOMEN'S REPORT, THE IMPLEMENTATION PLAN FOR THE 17 RECOMMENDATIONS THAT THIS IMPORTANT TASK FORCE HAS DEVELOPED. SO WE LOOK FORWARD TO HEARING MORE ABOUT THAT IN THE FUTURE. AMBASSADOR CONNIE MORELLA ALSO STATED AT THE TIME, THIS IS ABOUT THE FOUNDING OF ORWH AGAIN, AT THAT TIME, OUR BIPARTISAN, BICAMERAL FOURSOME LEARNED OF THE OMISSION OF WOMEN IN CLINICAL TRIALS AND PROTOCOLS. INTO THE OFFICE ESTABLISHED IN 1990 HAS MADE ALL THE DIFFERENCE! LET'S CONTINUE. SO MORE WORK TO BE DONE. AND FOR A COVID-19 UPDATE AT HIGH LEVEL, I'M PLEASED TO SHARE THE NIH WIDE ROAD MAP FOR COVID-19 RESEARCH. IT SERVE AS A ROAD MAP FOR COVID-19 RESEARCH AND I WANT TO MAKE SURE THAT YOU'RE AWARE IT INCLUDES PREGNANCY-RELATED IMPACTS IN ITS PRIORITIES. IF YOU LOOK ON THE RIGHT, YOU CAN SEE PRIORITY 5, PREVENT AND ADDRESS -- EXCUSE ME -- AND ADDRESS POOR COVID-19 OUTCOMES. THAT INCLUDES COVID-VULNERABLE POPULATION, HEALTH DISPARITY POPULATIONS, INCLUDING PREGNANT AND LACTATING WOMEN. THERE ARE SELF CROSS-CUTTING STRATEGIES THAT ARE INCLUDED IN THE STRATEGIC PLAN THAT SPECIFICALLY ADDRESS THE HEALTH OF WOMEN, SO PLEASE TAKE A LOOK AT THIS NIH-WIDE STRATEGIC PLAN FOR COVID-19 RESEARCH THAT'S GUIDING OUR EFFORTS. AND OF COURSE YOU'RE GOING TO HEAR MORE ABOUT THIS LATER TODAY. FROM AN ORWH PERSPECTIVE, WE HAVE SOUGHT TO LEVERAGE THE COLLECTIVE STRENGTH OF THE INSTITUTES CENTERS AND OFFICES ACROSS NIH TO ACCELERATE SEX AND GENDER RESEARCH ON COVID-19'S IMPACTS ON WOMEN'S HEALTH. WE HAVE PARTICIPATED IN THE DEVELOPMENT OF 15 FUNDING OPPORTUNITY ANNOUNCEMENTS ACROSS THE INSTITUTES AND CENTERS. WHEN WE PARTICIPATE IN THE DEVELOPMENT OF THOSE FOAs, WE OFTEN ARE ABLE TO INCLUDE LANGUAGE SPECIFIC TO THE HEALTH OF WOMEN OR TO CONSIDERING SEX AND GENDER. WE ALSO AND MANY MEMBERS OF ORWH HAVE PARTICIPATED IN FAST TRACK REVIEWS OF COVID-19 PROPOSALS, AT THIS POINT OVER 20 REVIEWS, CONTRIBUTING AND SERVING NIH IN THAT REGARD. IN ADDITION, WE HAVE PROVIDED SPECIFIC STRATEGIES FOR INCORPORATING SEX AS A BIOLOGICAL VARIABLE AND ADDRESSING BOTH THE SABV AND NIH'S INCLUSION POLICY INTO COVID-19 RESEARCH. AUTHORING AL GUIDING PRINCIPLES DOCUMENT ON SEX AND GENDER INFLUENCES IN COVID-19 AND THE HEALTH OF WOMEN. MAKING THAT AVAILABLE TO OUR COLLEAGUES AT NIH TO INCREASE AWARENESS AND UNDERSTANDING OF HOW IMPORTANT IT IS TO ADDRESS THESE ISSUES. IN ADDITION, WE LEVERAGED OUR OWN SIGNATURE RESEARCH PROGRAMS TO EXPAND THEIR SCOPE TO MEET THE CHALLENGES OF THE COVID-19 PANDEMIC. SPECIFICALLY, OUR SEX AND GENDER R01 HAS BEEN EXPANDED TO INCORPORATE ADDRESSING COVID-19 AS PART OF ITS SCOPE, AND OUR FUNDING OPPORTUNITY, OUR NOTICE OF SPECIAL INTEREST ON ADDRESSING UNDERSTUDIED, UNDER REPORTED, UNDER REPRESENTED POPULATIONS OF WOMEN, OUR U3 NOSY ALSO HAS 3 NOSI ALSO HAS BEEN EXPA NDED TO INCLUDE COVID-19 IN ITS SCOPE. I WAS EXCITED TO SEE SO MANY OF OUR SCORE INVESTIGATORS AUTHORING PIECES VERY EARLY ON, ADDRESSING THESE SEX DIFFERENCES AS WELL. AND ALSO ISSUES RELATED TO THE HEALTH OF WOMEN INCLUDING PREGNANT WOMEN. IN ADDITION, TEAM ORWH IN COLLABORATION WITH THE NATIONAL INSTITUTE OF MINORITY HEALTH AND DEVELOPMENT, MINORITY HEALTH AND HEALTH DISPARITIES AS WELL AS THE SGMRO OFFICE WHO CONTRIBUTED TO AN ANNOTATED BIBLIOGRAPHY ON ISSUES GERMANE TO SEX AND GENDER AND COVID, MAKING THAT INFORMATION AVAILABLE AS WELL. WE WROA PROMOTED COLLABORATION ACROSS NIH BY FORMING A COVID-19 WORKING GROUP UNDER THE NIH COORDINATING COMMITTEE FOR RESEARCH ON WOMEN'S HEALTH WHICH INCLUDES REPRESENTATIVES FROM ALL 27 INSTITUTES AND CENTERS. YOU CAN SEE THE CO-CHAIRS THERE. THE PURPOSE OF THAT WORKING GROUP IS TO PERFORM PORTFOLIO ANALYSIS ACROSS THE COVID-19 EFFORTS, FOAs AND INITIATIVES RELATED TO EXAMINING HOW SEX AND GENDER IN WOMEN'S HEALTH ARE BEING ADDRESSED TO IDENTIFY GAPS IN OUR PORTFOLIO, TO SET WOMEN'S HEALTH RESEARCH PRIORITIES RELATED TO COVID, AND TO ACCELERATE AND PROMOTE RESEARCH IN THESE AREAS. SO YOU WILL HEAR LATER TODAY ABOUT MANY OF THE COVID-19-RELATED STRATEGIES THAT NIH IS UNDERTAKING, BUT I WANT TO JUST HIGHLIGHT AT A VERY HIGH LEVEL THE ACTIVE PARTNERSHIP, ACTIVE STANDS FOR ACCELERATING COVID-19 THERAPEUTIC INTERVENTION AND VACCINES. IT IS A ONE OF A KIND PUBLIC-PRIVATE COLLABORATION THAT'S PURSUING FOUR FAST TRACKED AREAS IDENTIFIED HERE, AND THE RADX DIAGNOSTICS PROGRAM THAT IS FOCUSED JUST ON COVID-19 TESTING, EITHER FOR UNDERSTUDIED INDIVIDUALS TO EXPAND PLATFORMS, TO DEVELOP NEW TECHNOLOGIES, AND TO BASICALLY PUT ALL OF OUR ENERGY BEHIND COVID-19 TESTING TECHNOLOGIES. SO I'M LOOKING FORWARD TO OUR PRESENTATIONS LATER TODAY ON COVID-19 AND THESE ACTIV AND RADX PROGRAMS. WE DO KNOW THAT EVEN IN THE POPULAR PRESS, WE'VE HEARD ABOUT MEN'S POORER OUTCOMES IN COVID-19. AND THIS PIECE FROM NATURE AUTHORED BY DR. IWASAKI HIGHLIGHTED SEX DIFFERENCES IN IMMUNE RESPONSES THAT MAY EXPLAIN SOME OF THE DISEASE OUTCOMES WE SEE. GOING INTO THIS, WE ALREADY KNEW FROM WORK DONE BY SABRA KLEIN AND OTHERS THAT WOMEN MOUNT A VERY ROBUST T-CELL ACTIVATION RESPONSE IN RESPONSE TO MANY VIRAL INFECTIONS, BUT WHAT WE LEARNED FROM DR. IWASAKI'S PAPER IS THAT THERE ARE DISTINCT IMMUNE RESPONSES THAT ARE ASSOCIATED WITH EITHER DETERIORATION OR POOR OUTCOME THAT MAY PREDICT SYMPTOM SEVERITY IN MEN AND WOMEN. SO AT THE VERY BEGINNING, MEN AND WOMEN TEND TO HAVE -- THOSE WITH MODERATE COVID-19 SYMPTOMS, FOR EXAMPLE, HAVE DIFFERENT IMMUNE PROFILES. CAN YOU SEE HERE DATA FROM MALE AND FEMALE PATIENTS AND MALE AND FEMALE HEALTHCARE WORKERS WITH DIFFERENCES IN THEIR PATTERNS OF INNATE HUMAN -- INNATE CYTOKINES, HERE ARE A FEW OF THEM DELINEATED. ON THE PO TOM WHAT YOU SEE IS THE CASE DETERIORATION ASSOCIATED WITH DISTINCT IMMUNE PROCESSES BETWEEN THE SEXES. AND I'M NOT GOING TO GO INTO DETAIL JUST BECAUSE THERE'S A LOT OF REALLY ELEGANT WORK IN THIS PAPER, BUT JUST THE SEX DIFFERENCES IN THESE IMMUNE PROFILES AND THESE PATTERNS HIGHLIGHT HOW IMPORTANT IT IS TO INCORPORATE SABV INTO COVID-19 RESEARCH, AND HOW CRITICAL IT IS TO DIG AGGREGATE THE DATA THAT IS BEING COLLECTED FOR COVID-19 RESEARCH BY SEX AND BY AGE. IN TERMS OF SCIENTIFIC COLLABORATIONS ACROSS NIH, I'M JUST GOING TO HIGHLIGHT A FEW FOR YOU HERE. MATERNAL MORTALITY AND MORBIDITY AND MATERNAL HEALTH DISPARITIES HAS BEEN AN AREA OF FOCUS. I'VE BEEN PRIVILEGED TO CO-CHAIR ALONG WITH THE DIRECTORS OF THE NATIONAL INSTITUTE OF CHILD HEALTH AND HUMAN DEVELOPMENT, DR. DIANA BIANCHI AND DR. TEAR A TARA SCHWETZ, AND I'M PLEASED TO SHARE WITH YOU THE IMPROVE INITIATIVE WHICH IN FY 2020 GRANTED OVER $7 MILLION FOR RESEARCH FOCUSED ON MATERNAL MORTALITY. WITH THE THREE TOPIC AREAS PRIORITIZED THAT YOU SEE HERE. CARDIOVASCULAR DISEASE, INFECTION AND IMMUNITY AND MENTAL HEALTH. AN IMPROVED WEBSITE WAS RECENTLY LAUNCHED AND YOU CAN SEE AT THAT WEBSITE ALL OF THE DIFFERENT APPLICATIONS THAT WERE FUNDED AND THE RANGE OF AREAS OF SCIENCE THAT ARE NOW SUPPORTED UNDER IMPROVE. WE ALSO PARTNERED WITH NIGMS ON THEIR INSTITUTIONAL DEVELOPMENT AWARD STATES PROGRAM TO PROVIDE ADMINISTRATIVE SUPPLEMENTS TO EXPAND RESEARCH AND RESEARCH CAPABILITY AT NEARLY $5 MILLION, AND THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES LED THE DEVELOPMENT OF A NEW R01, INTERSECTION OF DOMAINS AND LEVELS OF INFLUENCE AND THEY ALSO INCORPORATE IS VEER MORTALITY MORBIDITY DISPARITIES IN THEIR WORK. THE U3 PROGRAM IN THE LAST FOUR YEARS HAS SUPPORTED OVER 50 AWARDS FOCUSED ON UNDER STUDIED, UNDER REPORTED AND UNDER REPRESENTED POPULATIONS OF WOMEN, INCLUDING THIS YEAR ON BIOLOGICAL AND SOCIAL DETERMINANTS OF SEVERE MATERNAL MORBIDITY, AND IN THE PAST ON SICKLE CELL DISEASE IN MATERNAL HEALTH AND FIBROID GROWTH IN MATERNAL HEALTH. HERE YOU CAN SEE AT THE NIGMS WEBSITE HIGHLIGHTING THIS NEW WOMEN'S HEALTH RESEARCH PROGRAM IDEA PROGRAM. I'D ASK THAT YOU TAKE A LOOK THERE AND SEE THE RANGE OF ACTIVITIES THAT ARE SUPPORTED. IN TERMS OF OUR ROBUST RESPONSE TO MATERNAL MORTALITY, IN THE LAST SEVERAL MONTHS, WE COLLABORATED WITH NICHD ON THE PREGNANCY AND MATERNAL CONDITIONS THAT INCREASE RISK OF MORBIDITY AND MORTALITY WORKSHOP IN MAY, AND THEN WITH NINR, NICHD AND NI MHD, WORKSHOP ON MODELS OF CARE FOR REDUCING DISPARITIES IN MATERNAL HEALTH. THAT ADDRESSED VETTINGS OF CARE. OUR OWN MATERNAL MORTALITY PORTAL LED BY ORWH IS A ONE STOP SHOP WITH INFORMATION FROM ACROSS NIH AS WELL AS OUR FEDERAL PART MER PARTNERS, SO TAKE A LOOK THERE AND YOU CAN BE UPDATED ON THOSE AREAS AND NEW RESOURCES AVAILABLE AND WE UPDATED OUR MATERNAL MORTALITY AND MORBIDITY BROCHURE AND THAT'S AVAILABLE ON THE PORTAL. OUR INCLUSION INITIATIVES ARE ALWAYS AT THE FOREFRONT. AS YOU HEARD, A LACK OF INCLUSION OF WOMEN IN CLINICAL RESEARCH WAS PART OF THE IMPETUS INFORMING NIH. SO WE'RE EXCITED TO BE WELCOMING DR. MONICA WEBB HAO HOOPER, WOULD WILL BE TALKING ABOUT A VARIETY OF NIH EFFORTS IN THIS SPACE AND A PANEL LATER TODAY. ONE OF THOSE EFFORTS INCLUDES THE SEAL INITIATIVE, COMMUNITY ENGAGEMENT ALLIANCE AGAINST COVID-19 DISPARITIES. INFORMATION IS NOW AVAILABLE IN THE CEAL WEBSITE ABOUT THE STEPS THAT NIH IS TAKING TO ADDRESS DI SPAIRTS, HEALTH DISPARITIES IN COVID-19 AND THE NEED FOR ENGAGEMENT ACROSS THE BOARD AT THE COMMUNITY LEVEL AND ACROSS AREAS THAT HAVE HAD LOW PARTICIPATION IN NIH SUPPORTED RESEARCH AND IN RESEARCH GENERALLY. I WAS PLEASED TO PARTICIPATE IN RESEARCH AMERICA'S RECENT ANNUAL MEETING ANSWERING THE QUESTION, IS THERE AN AREA OF SCIENCE THAT DESERVES MORE ATTENTION THAN IT RECEIVES? OF COURSE MY ANSWER WAS INCLUSION AND THE STUDY OF SEX AS A BUY BIOLOGICAL VARIABLE. THAT 30-SECOND CLIP IS AVAILABLE ON RESEARCH AMERICA'S WEBSITE. WE RECENTLY PARTNERED WITH THE NATIONAL INSTITUTE ON AGING, AND NICHD, AS WELL AS OUR COLLEAGUES AND OTHER ICs IN THE NIH INCLUSION ACROSS THE LIFESPAN 2 WORKSHOP IN SEPTEMBER. THAT REPORT WILL BE AVAILABLE SOON. AND IN TERMS OF ONLINE COURSE WORK WHICH WE'VE SEEN A SIGNIFICANT UPTICK ACROSS THE BOARD AT NIH, DR. NOURSI AND I DELIVERED LECTURES ON THE NIH INCLUSION POLICY FOR THE 2020-2021 NIH INTRODUCTION TO THE PRINCIPLES OF PRACTICE OF CLINICAL RESEARCH COURSE THAT IS FREELY AVAILABLE ONLINE. IT'S REACHED OVER 8,000 INDIVIDUALS AROUND THE WORLD. THE INCLUSION TOOLKIT, HOW TO ENGAGE AND RETAIN WOMEN IN RESEARCH IS AVAILABLE ON OUR WEBSITE AND WE CONTINUE TO PARTNER WITH THE FDA OFFICE OF WOMEN'S HEALTH IN DIVERSE IN CLINICAL TRIALS COLLABORATION. CAN YOU SEE THE LOGO YOU CAN SEE THE LOGO. IT INCLUDES SOCIAL MEDIA AND OTHER CONTENT FOR ORGANIZATIONS IN THE COMMUNITY THEY CAN USE TO ENCOURAGE PARTICIPATION. NIH -- EXCUSE ME, NEXT SLIDE, PLEASE. THE LAST OF THE FOURSOME IN THAT ORIGINAL GROUP. FORMER REPRESENTATIVE PAT SCHROEDER SAID 30 YEARS LATER -- THIS IS WHAT SHE SAID ON THE OCCASION OF OUR ANNIVERSARY. 30 YEARS LATER, THE GOAL OF KNOWING AS MUCH ABOUT WOMEN'S HEALTH AS MEN'S GETS CLOSER EVERY YEAR. SHE ENCOURAGED US TO POWER ON. IN TERMS OF RESEARCH INVESTMENTS, NEXT YOU CAN SEE A BREAKDOWN OF OUR FUNDING AT ORWH, OUR BUDGET HISTORY OVER OUR HISTORY FROM FORMATION AND ON THE RIGHT, YOU CAN SEE THE PIE CHART FOR THE BREAKDOWN OF OUR SIGNATURE PROGRAMS IN TERMS OF OUR RESEARCH INVESTMENTS. SO THE BIRCWH PROGRAM, TOP 20%, AND OUR CAREER CONCEPTS THAT I INTRODUCED AT THE LAST MEETING, OUR SPECIALIZED RESEARCH ON SEX DIFFERENCES, OUR SCORE PROGRAM, NIH'S ONLY DISEASE-AGNOSTIC SEX DIFFERENCES CENTER LEVEL PROGRAM, OUR STRATEGIC RESEARCH PARTNERSHIPS, COFUNDING WITH INSTITUTES AND CENTERS, THE SEX AND GENDER ADMINISTRATIVE SUPPLEMENTS, THE NEW R01 ON SEX AND GENDER AND OUR U3 ADMINISTRATIVE SUPPLEMENTS. JUST A FEW EXAMPLES OF TEAM ORWH MEMBERS PRESENTING AROUND -- I WAS GOING TO SAY AROUND THE COUNTRY BUT ALL VIRTUALLY THESE DAYS ON SABV, DR. SHARON HUNTER PRESENTED AT THE SEX AND GENDER HEALTH EDUCATION SUMMIT AND DR. REBECCA DELCARMEN-WIGGINS AT THE 2020 AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY, THEIR ANNUAL MEETING. WE THOUGHT THAT IT WAS IMPORTANT TO PUT OUT INFORMATION ABOUT STRESS, MANAGING STRESS AND BUILDING RESILIENCE, AND INFORMATION THAT IS PLAIN LANGUAGE THAT WOULD BE WIDELY AVAILABLE, INCLUDING IN LIBRARIES, SCHOOLS, SENIOR CENTERS AND COMMUNITY HEALTH CLINICS. I'M PLEASED TO SHARE WITH YOU THAT THAT ARTICLE HAS REACHED OVER 300,000 INDIVIDUALS AND WAS FEATURES IN THE NIH NEWS AND HEALTH NEWSLETTER AND HAS BEEN PROVIDED TO A VARIETY OF INDIVIDUALS AS I MENTIONED AND THE GENERAL PUBLIC, ENCOURAGING INDIVIDUALS IN THE CONTEXT OF COVID-19 TO MANAGE STRESS AND BUILD RESILIENCE AS BEST WE CAN. OUR STAFF HAVE BEEN VERY BUSY WITH PUBLICATIONS. I WANT TO HIGHLIGHT ONE OR TWO FOR YOU. THE INTERSECTION OF A TRIAL OF MORBIDITY AND MORTALITY AND INTIMATE PARTNER VIOLENCE. THAT ARE OFTEN NOT AT THE FOREFRONT OF EVERYONE'S MIND. I WAS PLEASED TO CO-AUTHOR WITH ACRWH DR. JUDITH REGENSTEINER ON THE IMPORTANCE OF CURRICULUM DEVELOPMENT IN THE 21ST CENTURY. WE CONTINUE TO CONDUCT FACEBOOK LIVE EVENTS. OUR YOUNGER COLLEAGUES HAD ASKED US TO ENGAGE ON SOCIAL MEDIA AS WHERE THEY WANT TO BE ABLE TO HAVE DISCUSSIONS WITH US ABOUT WOMEN IN SCIENCE, AND WE HAD SEVERAL INDIVIDUAL SPEAKERS AND THEN TWO PANELS VERY RECENTLY THAT INCLUDED DR. CORBETT WHO IS PLAYING A LEAD ROLE IN SOME OF THE RESEARCH AT NIAID, DR. TANNER, RECENTLY NEWLY TENURED AFRICAN AMERICAN WOMAN SCIENTIST AT NIH, AND OTHER COLLEAGUES LED BY DR. TIGNA, WHO MODERATED THAT FACEBOOK LIVE. DR. TIGNA WAS OUR NEW ASSOCIATE DIRECTOR FOR CAREERS. IN TOTAL, OVER 30,000 INDIVIDUALS HAVE BEEN REACHED BY OUR FACEBOOK LIVE EVENTS. I ENCOURAGE YOU TO JOIN OUR WOMEN OF COLOR RESEARCH NETWORK ON LINKEDIN, WHERE WE'RE ALSO CONNECTING AND SHARING INFORMATION RELEVANT TO WOMEN IN SCIENCE WITH A PARTICULAR FOCUS ON WOMEN OF COLOR AND INDIVIDUALS WHO ARE INTERESTED IN SUPPORTING WOMEN OF COLOR IN THE BIOMEDICAL RESEARCH ENTERPRISE. AS I END HERE, I WANT TO HIGHLIGHT FOR YOU AND I WANT TO COMMEND OUR COMMUNICATIONS TEAM LED BY MR. LaMONT WILLIAMS. OVER THE PAST YEAR, OUR WOMEN'S HEALTH IN FOCUS AT NIH QUARTERLY PUBLICATION HAS HIGHLIGHTED OUR MAJOR MISSION AREAS. WE STARTED OFF ON THE HISTORY OF THE OFFICE, WE MOVED TO CAREERS, WE HAD AN ISSUE ON SABV AND OUR MOST RECENT ISSUE IS FOCUSED ON INCLUSION. THESE FOR ISSUES OF WOMEN'S HEALTH IN FOCUS CONSTITUTE OUR 30TH ANNIVERSARY ISSUES. YOU CAN SIGN UP TO RECEIVE THESM HERE AT THE WEBSITE, BUT I DO WANT TO ACKNOWLEDGE OUR NIH COLLEAGUES ACROSS THE BOARD WHO HAVE COLLABORATED WITH US ON THE DEVELOPMENT OF THESE, OUR ENTIRE COMMUNICATIONS CREW AND MR. LaMONT WILLIAMS FOR LEADING THE DEVELOPMENT OF THE IN FOCUS QUARTERLY AND PROVIDING SENIOR EDITORSHIP THERE. OUR MONTHLY EMAIL IS ALSO CALLED "THE PULSE," SO PLEASE SUBSCRIBE TO THAT THERE WHERE YOU CAN LEARN MORE ABOUT US AND OUR 30TH ANNIVERSARY EVENTS. SO THIS IS MY LAST SLIDE AND I WANT TO MAKE SURE YOU'RE AWARE OF OUR 30TH ANNIVERSARY VIRTUAL MEETING SERIES, DECEMBER 14TH THROUGH THE 16TH, WHERE WE WILL BE OOD ADVANCING THE HEALTH OF WOMEN THROUGH SCIENCE, FROM A RESEARCH PERSPECTIVE, ADDRESSING INCLUSION, ADDRESSING CAREERS, AND A VARIETY OF TOPICS. SO PLEASE JOIN US IN DECEMBER FOR THAT. AND CONNECT WITH US AT THESE COORDINATES THAT ARE LISTED HERE BELOW. THANK YOU FOR YOUR ATTENTION. SO MICHAEL, WE CAN GO TO THE NEXT. I BELIEVE NEXT UP -- JUST ONE MOMENT. I'M GOING TO BE ABLE TO INTRODUCE DR. HELENE LANGEVIN AS SOON AS I FIND MY PLACE. JUST A MOMENT. ACTUALLY I'M GOING TO BE INTRODUCING DR. ELENA WHO WILL BE INTRODUCING OUR NEXT SPEAKER. SHE'S A HEALTH SCIENTIST ADMINISTRATOR AND RESEARCH PROGRAM OFFICER AT ORWH. ELENA? >> CAN YOU HEAR ME? GOOD MORNING. >> YES. >> GOOD MORNING. IT IS MY PRIVILEGE TO INTRODUCE DR. HELENE LANGEVIN, DIRECTOR OF THE NATIONAL CENTER OF FULL COMPLEMENTARY HEALTH. PRIOR TO HER ARRIVAL, SHE WORKED AT THE OSHA CENTER FOR INTEGRATIVE MEDICINE JOINTLY BASED IN BRIGHAM AND WOMEN'S HEALTH AND HARVARD MEDICAL SCHOOL, BOSTON. DR. LANGEVIN SERVED AS DIRECTOR OF THE OSHA CENTER AND PROFESSOR IN RESIDENCY OF MEDICINE AT HARVARD MEDICAL SCHOOL SINCE 2012. SHE HAS ALSO SERVED AS A VISITING PROFESSOR OF NEUROLOGICAL SCIENCE AT THE UNIVERSITY OF VERMONT. AS A PRINCIPAL INVESTIGATOR OF THE SEVERAL NIH FUNDED STUDIES, DR. LANGEVIN'S RESEARCH INTERESTS HAVE CENTERED AROUND THE ROLE OF COULD NECK TESTIFY CONNECTIVE TISSUE IN CHRONIC MUSCULOSKELETAL PAIN AND ACUPUNCTURE, MANUAL AND MOVEMENT-BASED THERAPIES. HER MORE RECENT WORK HAS FOCUSED ON THE EFFECT OF STRETCHING ON INFLAMMATION RESOLUTION MECHANISM IN CONNECTIVE TISSUE. SHE HAS AUTHORED MORE THAN 70 ORIGINAL SCIENTIFIC PAPERS AND IS A FELLOW OF THE AMERICAN COLLEGE OF PHYSICIANS. AS NCCH DIRECTOR, DR. LANGEVIN OVERSEES THE FEDERAL GOVERNMENT'S LEAD AGENCY FOR SCIENTIFIC -- ON THE DIVERSE MEDICAL AND HEALTHCARE SYSTEM, PRACTICES AND PRODUCTS THAT ARE NOT GENERALLY CONSIDERED PART OF CONVENTIONAL MEDICINE. PLEASE JOIN ME IN WELCOMING DR. HELENE LANGEVIN. THANK YOU. >> THANK YOU VERY MUCH, DR. GO RODETSKY AND DR. CLAYTON FOR THE WONDERFUL INVITATION TO PRESENT AT THE COUNCIL. I'M VERY EXCITED TO TALK ABOUT OUR ONGOING STRATEGIC PLANNING PROCESS AT NCCIH. I WAS VERY INTERESTED IN FOLLOWING THE PROCESS OF ORWH'S STRATEGIC PLANNING LAST YEAR, AND IT WAS WONDERFUL TO HEAR THAT -- ACTUALLY LET ME START MY -- START SHARING MY SLIDE AS I TALK. IT WAS REALLY WONDERFUL TO HEAR ABOUT THE FOCUS OF ORWH ON THE HEALTH OF WOMEN AS A WHOLE, NOT JUST GYNECOLOGICAL PIECES OF WOMEN. AND YOU KNOW, THIS IS VERY IMPORTANT TO US AT NCCIH, BECAUSE WE REALLY -- THAT'S WHY I WANT TO TALK ABOUT WHOLE PERSON HEALTH. THINKING OF AND ENVISIONING THE PEOPLE, INDIVIDUALS, AS WHOLES. CAN YOU ALL SEE MY SLIDES RIGHT NOW? >> YEP, YOU'RE ALL SET, HELENE. >> OKAY, VERY GOOD. SO WHAT IS WHOLE PERSON HEALTH? WELL, YOU KNOW, FOR US IT WAS A JOURNEY TO GET TO WHOLE PERSON HEALTH AND I WANT TO TELL YOU A LITTLE BIT HOW THIS HAPPENED. SO IN OUR PREVIOUS STRATEGIC PLAN, WITH THE PREVIOUS DIRECTOR OF NCCIH, DR. JOSIE BRIGGS, THERE WAS A VERY STRONG FOCUS FOR NCCIH ON PAIN. THIS WAS SOMETHING THAT WAS EXTREMELY IMPORTANT FOR NCCIH TO REALLY KIND OF EXPAND ITS EXPERTISE IN AN AREA OF PAIN MANAGEMENT WHICH WAS FELT AT THE TIME TO BE A GREAT NEED, AND ONE OF THE REASONS FOR THAT WAS THAT IF YOU LOOK AT THIS SURVEY FROM THE 2012 NATIONAL HEALTH INSTITUTE HEALTH INTERVIEW SURVEY, YOU SEE THAT THE TOP FOUR REASONS FOR PEOPLE TO SEEK COMPLEMENTARY INTERVENTIONS ARE BACK PAIN, NECK PAIN, JOINT PAIN, AND OTHER TYPES OF MUSCULOSKELETAL PAIN. SO YOU SEE THAT THIS IS AN AREA THAT WAS FELT THAT THIS IS WHY PEOPLE USE A LOT OF THESE INTERVENTIONS AND, THEREFORE, THERE NEEDED TO BE A LOT OF RESEARCH ON THIS. SO NCCIH FOCUSED ON PAIN AND DEVELOPED A VERY ROBUST PORTFOLIO. AT THE MOMENT, 40% OF THE GRANTS THAT NCCIH FUNDS ARE RELATED TO PAIN. EITHER BASIC OR CLINICAL RESEARCH. NOW, THIS IS INTERESTING BECAUSE AS FAR AS WHEN WE THINK ABOUT WOMEN, WOMEN WE KNOW USE COMPLEMENTARY HEALTH APPROACHES MORE THAN MEN DO, AND THIS IS CONSISTENT ACROSS SURVEYS THAT HAVE HAPPENED. BUT -- CHRONIC PAIN AT SLIGHTLY HIGHER RATES THAN MEN FOR BOTH CHRONIC PAIN AND ALSO WHAT WE CALL HIGH IMPACT CHRONIC PAIN, THAT REALLY IMPAIRS THE ABILITY OF THE INDIVIDUAL TO FUNCTION. BUT THAT'S NOT THE WHOLE STORY, BECAUSE IF YOU ASK, THERE WAS A FOLLOW-UP TO THE 2012 NATIONAL HEALTH SURVEY THAT ASKED THE QUESTIONS SLIGHTLY DIFFERENTLY ABOUT WHY PEOPLE WERE SEEKING THE USAGE OF COMPLEMENTARY INTERVENTIONS AND THE IDEA THAT, FOR EXAMPLE, YOU HAVE THREE EXAMPLES HERE, NATURAL PRODUCTS, YOGA AND SPINAL MANIPULATION. WHEN PEOPLE WERE ASKED, ARE YOU SEEKING, ARE YOU UTILIZING THIS TREATMENT FOR A SPECIFIC CONDITION OR FOR SOMETHING MORE RELATED TO WELLNESS, FOR EXAMPLE, DIFFERENT TYPES OF LIKE WELL-BEING, GENERAL SUPPORTIVE HEALTH. YOU CAN SEE THAT AT LEAST FOR THE NATURAL PRODUCTS AND FOR THE YOGA, OVERWHELMINGLY, THERE WAS -- THE REASON WHY THIS PARTICULAR THERAPY OR PRACTICE WAS USED WAS BECAUSE OF NOT A SPECIFIC CONDITION. AND SO WE ARE STARTING TO REALLY THINK ABOUT HOW THESE INTERVENTIONS ARE UTILIZED IN THE REAL WORLD, AND THAT WE REALLY NEED TO UNDERSTAND BETTER, WHAT IS IT ABOUT SOME OF THESE INTERVENTIONS THAT CAN HELP PEOPLE WITH THEIR GENERAL WELL-BEING AND HEALTH? SO WHAT WE STARTED TO DO IS WE STARTED TO EXAMINE THE ACTUAL DEFINITIONS OF NCCIH OF THIS. AND I WANT TO TAKE YOU THROUGH THE ACTUAL LETTERS THAT COMPOSE THE NAME NCCIH, STARTING WITH THE MIDDLE C. C MEANS COMPLEMENTARY. AND HERE, WHAT WE HAVE DONE IS WE HAVE MAPPED SOME OF THESE INTERVENTIONS THAT ARE TERMED COMPLEMENTARY. NOW, COMPLEMENTARY, BEFORE NCCIH WAS CALLED NCCIH USED TO BE CALLED NCCAM OR NATIONAL CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE. THE TERM "ALTERNATIVE" WAS ACTUALLY DROPPED BECAUSE IT WAS FELT THAT THESE INTERVENTIONS REALLY ARE MEANT TO BE USED AS A COMPLEMENT TO CONVENTIONAL MEDICINE, NOT AS AN ALTERNATIVE. AND SO THE TERM COMPLEMENTARY REFERS TO A GROUP OF INTERVENTIONS THAT WE HAVE MAPPED HERE IN THREE GENERAL LARGE CATEGORIES: DIETARY, PSYCHOLOGICAL, AND PHYSICAL. AND YOU CAN SEE IS THAT THERE IS SOME OVERLAP BETWEEN THESE CATEGORIES. SO DIETARY INTERVENTIONS INCLUDE FOODS, VITAMINS, MINERALS, PROBIOTICS, HERBAL FORMULAS. THEY ALSO INCLUDE NUTRITIONAL SUPPLEMENTS THAT CAN BE USED IN HIGHER DOSES ESSENTIALLY AS DRUGS TO TREAT A SPECIFIC CONDITION, AND SO YOU SEE THERE'S A SLATE OVERLAP BETWEEN THE DIETARY INTERVENTION AND THE PHARMACEUTICAL IF YOU SAY YOU'RE DEALING WITH A SPECIFIC COMPOUND THAT'S BEING EXTRACTED, LIKE A LOT OF DRUGS ARE, FOR EXAMPLE, DRUGS THAT WE USE ALL THE TIME, DIGITALIS, ASPIRIN, ET, WERE DERIVED FROM PLANTS. SO THIS COMPLETED THIS PROCESS OF DEVELOPING DRUGS BASED ON NATURAL PRODUCTS AS AN ONGOING ONE. BUT THERE'S A STRONG USAGE AMONG THE POPULATION IN, FOR EXAMPLE, OVER THE COUNCIL AT THE SUPPLEMENTS COUNTER SUPPLEMENTS THAT PEOPLE USE FOR A VARIETY OF REASONS SUPPORTING THEIR HEALTH. AND WE NEED A LOT MORE RESEARCH ON THIS AS FAR AS THE SAFETY, THE EFFICACY AND MAKING SURE THERE'S NO INTERACTIONS BETWEEN THOSE SUPPLEMENTS AND ANY OTHER MEDICATIONS THAT THEY'RE TAKING. NOW, AS FAR AS THE PSYCHOLOGICAL CATEGORY, THERE ARE SOME OF THESE TYPES OF INTERVENTIONS OR PRACTICES THAT ARE MORE MAINSTREAM THAN OTHERS. YOU CAN SEE, FOR EXAMPLE, MEDITATION, FOR EXAMPLE, OR CBT OR COGNITIVE BEHAVIOR THERAPY. THERE'S A BIT OF A BLURRING OF THE LINES BETWEEN WHAT'S CONVENTIONAL AND WHAT'S COMPLEMENTARY HERE. FOR EXAMPLE, A LOT OF PRETTY CONVENTIONAL COGNITIVE BEHAVIOR THERAPY IS NOW STARTING TO INCORPORATE ELEMENTS OF, SAY, WHAT WE CALL MINDFULNESS-BASED RELAXATION TECHNIQUES LIKE THEY CALL NBSR. ALSO SIMPLE RELACKATION TECHNIQUES AND STRESS REDUCTION TECHNIQUES THAT ARE GRADUALLY GETTING INCORPORATED INTO MORE MAINSTREAM PRACTICES LIKE COGNITIVE BEHAVIORAL THERAPY. SO YOU SEE HERE THAT NOT ONLY -- THE LINE CAN BE BLURRED BETWEEN THE CONVENTIONAL AND THE COMPLEMENTARY, AS THESE COMPLEMENTARY INTERVENTIONS ARE GRADUALLY GETTING INTEGRATED INTO MAINSTREAM HEALTHCARE. YOU ALSO SEE AN AN OVERLAP BETWEEN THE PSYCHOLOGICAL AND DIETARY AS FAR AS MINDFUL EATING, PAYING ATTENTION TO ONE'S EATING HABITS, ET CETERA. NOW THE OTHER BIG CATEGORY IS PHYSICAL. SO THESE INCLUDE INTERVENTIONS SUCH AS, FOR EXAMPLE, MASSAGE OR MANUAL THERAPIES. OR CHIROPRACTIC MANIPULATIONS, THAT APPLY PHYSICAL FORCES EITHER PASSIVELY APPLIED TO THE BODY OR ACTIVELY, SAY DURING MOVEMENT, LIKE EXERCISE. THERE ARE AGAIN OVERLAP BETWEEN THE PSYCHOLOGICAL AND PHYSICAL. YOU HAVE, FOR EXAMPLE, YOGA AND TAI CHI THAT HAVE A STRONG PHYSICAL COMPONENT, A MOVEMENT COMPONENT, BUT ALSO A PSYCHOLOGICAL COMPONENT AS WELL. SOME RELAXATION, SOME FOCUSING ON THE BREATH, FOR EXAMPLE. AND THEN THERE'S ACUPUNCTURE, WHICH IS AN INTERESTING PLACE IN THIS DIAGRAM. ACUPUNCTURE NEEDLES ARE DEVICES, SO THEY KIND OF FIT AT THIS INTERSECTION BETWEEN DEVICES, PHYSICAL, BECAUSE IT APPLIES -- THERE'S PHYSICAL FORCES APPLIED TO THE BODY WHEN ACUPUNCTURE NEEDLES ARE INSERTED AND MANIPULATED, BUT ALSO WE KNOW THERE'S A STRONG COMPONENT OF -- PSYCHOLOGICAL COMPONENT TO ACUPUNCTURE AS WELL. AND THEN THERE ARE OTHER TECHNIQUES LIKE ELECTRICAL, MAGNETIC STIMULATION THAT START OVERLAPPING BETWEEN THE CONVENTIONAL AND THE COMPLEMENTARY. SO YOU SEE THIS AS A RICHLAND SCAPE WE'RE NOT ATTEMPTING AT THIS POINT SO MUCH AS TO DEFINE WHAT'S A COMPLEMENTARY OR -- BUT RATHER TO DESCRIBE WHAT IS THE RANGE OF INTERVENTIONS THAT PEOPLE WOULD, FOR EXAMPLE, UTILIZE AND PRACTICE, BUT ALSO WHAT TYPE OF RESEARCH THAT WE WOULD FUND. NOW IMPORTANTLY, THESE TYPE OF INTERVENTIONS ARE VERY OFTEN NOT UTILIZED IN ISOLATION WITH EACH OTHER. FOR EXAMPLE, IF YOU WOULD LOOK AT, FOR EXAMPLE, MANY CARDIAC REHABILITATION PROGRAMS, SOME OF THEM MAY UTILIZE A COMBINATION OF, SAY, DIET AND EXERCISE AND PERHAPS SOME STRESS MANAGEMENT TECHNIQUES LIKE MINDFULNESS BASED STRESS REDUCTION. SO THIS IS RATHER CONVENTIONAL. THERE ARE A LOT OF PROGRAMS LIKE THIS IN VARIOUS TYPES OF, SAY, CARDIAC REHAB. BUT THERE ARE ALSO EXAMPLES WHERE THEY'RE A LITTLE BIT MORE COMPLEMENTARY, WHERE, FOR EXAMPLE, TAI CHI MAY BE USED AS AN EXERCISE, FORM OF EXERCISE. AND SO YOU CAN SEE THAT THESE TYPES OF WHAT WE CALL MULTIMODAL THERAPIES THAT COMBINE DIFFERENT TYPES VERY OFTEN FROM THESE DIFFERENT DOMAINS OF DIETARY, PSYCH PSYCHOLOGICAL AND PHYSICAL THAT REALLY ARE BEGINNING TO ADDRESS MORE THE WHOLE PERSON. NOW THERE'S ALSO OTHER TYPES WHICH WE CALL MULTIMODAL THERAPEUTIC SYSTEMS, AND THIS IS AN EXAMPLE FROM TRADITIONAL CHINESE MEDICINE THAT UTILIZES THE COMBINATION OF DIET, HERBAL FORMULAS, ACUPUNCTURE, TAI CHI, SOFT TISSUE MANIPULATION, AND ALSO SOME APPLICATIONS OF HEAT OR COLD. SO YOU CAN SEE THIS IS A VERY COMPLEX MULTIMODAL INTERVENTION WHERE ACUPUNCTURE IS NOT USED IN ISOLATION FROM THE OTHER THERAPIES. AND SO THIS IS AN AREA WHERE WE'RE STARTING TO REALLY EXPLORE, HOW DO YOU DO RESEARCH ON THESE TYPES OF INTERVENTIONS USING RIGOROUS METHODS. WE'RE PAYING A LOT OF ATTENTION TO THAT AT NCCIH, HOW TO DEVELOP THE BEST WAY TO NOT ONLY UNDERSTAND THE TREATMENT, BUT ALSO THE DIAGNOSTIC PROCESS THAT UNDERLIES THESE TREATMENTS THAT MAY UTILIZE A THEORETICAL FRAMEWORK THAT MAY BE DIFFERENT FROM THAT OF CONVENTIONAL MEDICINE. SO IN SUMMARY, YOU CAN SEE THAT THIS IS THE DESCRIPTION THAT WE'RE NOW USING, THAT WE'RE USING IN OUR STRATEGIC PLAN THAT COMPLEMENTARY THERAPIES ARE PRACTICES, THERAPIES AND SYSTEMS THAT USE DIETARY, PSYCHOLOGICAL AND/OR PSYCHOLOGICAL APPROACHES THAT MAY HAVE ORIGINATED OUTSIDE OF CONVENTIONAL MEDICINE BUT MAY HAVE NOT. SO NOW LET'S MOVE ON TO THE NEXT LETTER, WHICH IS THE LETTER I. I IS FOR INTEGRATIVE. AND WHEN WE THINK ABOUT IN THE PAST, INTEGRATIVE HEALTH IS USUALLY THOUGHT OF AS THE INTEGRATION AS I SAID BEFORE YOU COMPLEMENTARY AND CONVENTIONAL TREATMENTS AND PRACTICES TOGETHER IN AN INTEGRATED WAY, NOT SEPARATE. THERE WAS A LOT OF CONCERN AT THE VERY BEGINNING OF BEGINNING TO UNDERSTAND IN THE 1990s, THERE WERE SOME SURVEYS THAT WERE PERFORMED ASKING PEOPLE, DO YOU USE DIFFERENT TYPES OF COMPLEMENTARY INTERVENTIONS. AND SURPRISING OVER 30% OF THE POPULATION BACK IN THE 1990s HAD SAID YES, BUT OF THOSE, 75% OF THOSE THAT SAID THEY UTILIZE THESE INTERVENTIONS DID NOT TALK TO THEIR DOCTORS OR THEIR HEALTHCARE PROVIDERS ABOUT IT. SO THIS WAS A WAKEUP CALL THAT REALLY THERE SHOULD NOT BE TWO SEPARATE SORT OF PATHS FOR PEOPLE TO SEEK HEALTHCARE, THEY SHOULD BE INTEGRATED. SINCE THEN, THERE'S BEEN A GREAT EVIDENT FROM THE PART EFFORT ON THE PART OF A LOT OF MEDICAL SCHOOLS AND HEALTHCARE SYSTEMS TO BEGIN TO INTEGRATE. SO THIS IS ABSOLUTELY VERY IMPORTANT. SO INTEGRATION OF COMPLEMENTARY AND CONVENTIONAL CARE IS A VERY IMPORTANT PART OF INTEGRATION. HOWEVER, RIGHT NOW, WE'RE MOSTLY THINKING THAT WE WANT THIS TO GO ONE STEP FURTHER. THE REASON FOR THIS IS BECAUSE IT DOESN'T MATTER IF YOU'RE TALKING ABOUT SIGHNESS SCIENCE OR EVEN MATHEMATICS OR PHILOSOPHY, THERE'S ALWAYS THESE SORT OF CROSS-CURRENTS OF ANALYSIS AND SYNTHESIS. ANALYSIS IS WHEN YOU BREAK THINGS DOWN INTO SPALLER SMALLER AND SMALLER PARTS, AND SYNTHESIS IS WHEN YOU KIND OF PUT THEM BACK TOGETHER. WHERE SYNTHESIS AND INTEGRATION ARE SYNONYMOUS. SO WHAT DO WE DO IN MEDICINE? WE BREAK THINGS DOWN. THAT'S WHAT WE DO. FROM THE VERY BEGINNING OF MEDICINE, BACK IN THE 19TH CENTURY WHERE PHYSIOLOGY, RIGHT, BROKE PEOPLE DOWN TO THEIR DIFFERENT COMPONENT OR SYSTEMS, RIGHT, CARDIOVASCULAR SYSTEM, RESPIRATORY SYSTEM, DIGESTIVE SYSTEM, AND PEOPLE BEGAN STUDYING THESE SYSTEMS KIND OF IN ISOLATION FROM EACH OTHER. THIS IS REALLY WHAT LED TO THE DEVELOPMENT OF THE MEDICAL SPECIALTIES AND ALSO ACADEMIC MEDICAL DEPARTMENTS, AND RESEARCH HAS FOLLOWED THESE SILOS WHERE PEOPLE GET CAUGHT UP INTO PIECES AND THIS IS KIND OF WHAT I WAS REFERRING TO EARLIER, I THINK SOMETIMES FOR WOMEN'S HEALTH, IT'S BEEN KIND OF SILOED INTO OBSTETRICS AND GYNECOLOGY, FORGETTING THE REST OF THE WOMAN. SO THE IDEA IS THAT WHAT WE HAVE DONE HERE VERY MUCH IS NOT ONLY WE HAVE A TENDENCY, VERY STRONG TENDENCY IN MEDICINE TO BE REDUCTIONISTIC, TO BREAK THINGS DOWN, BECAUSE THAT'S HOW YOU FIND OUT HOW THINGS WORK. BUT EVEN WITHIN AN ORGAN SYSTEM, WITHIN AN ORGAN, WITHIN A CELL, WE LOOK AT SIGNALING PATHWAY, MOLECULE, SMALLER AND SMALLER DOWN TO THE GENE LEVEL. SO WE'RE ALSO DOING ANALYSIS, PUTTING THINGS BACK TOGETHER, UNDERSTANDING PATHOPHYSIOLOGY. THAT'S BEEN THERE FROM THE START. BUT A VERY STRONG PULL TOWARDS MOLECULAR APPROACH TO UNDERSTANDING DISEASES HAS REALLY LED TO A PREDOMINANTLY CHEMICAL APPROACH TO TREATMENT, WHICH IS DRUGS. SO THIS IS NOT SURPRISING. I'M GOING TO GIVE YOU AN EXAMPLE OF WHY THIS IS IMPORTANT. I'M GOING TO TELL YOU A STORY ABOUT A 53-YEAR-OLD WOMAN WHO HAS TYPE 2 DIABETES. SHE'S OVERWEIGHT, AND SHE HAS A BMI OF 30. AND HER EFFORTS TO CONTROL HER BLOOD SUGAR WITH DIET HAS BEEN UNSUCCESSFUL. A HEALTHCARE PROVIDER STARTS HER ON METFORMIN AND THEN GLIPIZIDE, HER A1C HAS BEEN IN NORMAL RANGE FOR THE PAST TWO YEARS ALTHOUGH HER BMI IS NOW 32. SHE HAS A 10-YEAR HISTORY OF HYPERTENSION THAT WAS CONTROLLED WITH HYDROCHLOROTHIAZIDE UNTIL SIX MONTHS AGO, WHEN AN ACE INHIBITOR WAS ADDED. THIS WAS DISCONTINUED TWO MONTHS LATER, DUE TO A PERSISTENT DRY COUGH AND A BETA-BLOCKER WAS ADDED TO HER REGIMEN. HER BLOOD PRESSURE IS STILL SLIGHTLY ELEVATED. THE -- COUGH IMPROVED BUT HAS NOT COMPLETELY SUBSIDED. SHE ALSO HAS OSTEOARTHRITIS OF THE RIGHT KNEE [INAUDIBLE]. SHE ALSO HAS A LONG HISTORY OF ANXIETY, DIFFICULTY SLEEPING, AND INTERMITTENT EPIGASTRIC PAIN CONTRIBUTED TO GASTROESOPHAGEAL REFLUX. SHE'S BEEN PRESCRIBED AMBIEN TO TAKE AS NEEDED FOR SLEEP AND PRILOSEC FOR HER HEARTBURN. SHE'S CONCERNED THAT HER G.I. SYMPTOMS ARE DUE TO ONE OF HER DIABETES MEDICATIONS BUT WAS STRONGLY ENCOURAGED TO STAY ON THEM BECAUSE THEY ARE SUCCESSFULLY CONTROLLING HER BLOOD SUGAR. SHE ALSO HAS A SLIGHT IRON DEFICIENCY MORE THOUGHT FROM A G.I. SOURCE. SHE WAS ALSO TOLD TO DISCONTINUE MOTRIN AND TAKE TYLENOL INSTEAD. 30 YEARS LATER, DIABETES AND HYPERTENSION ARE STILL UNDER REASONABLE CONTROL BUT HER INSOMNIA AND CHRONIC KNEE PAIN ARE INCREASINGLY PROBLEMATIC. SHE'S NOT BEEN ABLE TO SLEEP AT ALL WITHOUT MEDICATION FOR MANY YEARS. SHE'S HAD SOME COGNITIVE DECLINE, DAY TIME SOME EU LENS. IN AN ATTEMPT TO WEAN HER, SHE HAS RECENTLY DEVELOPED WORSENING TACHYCARDIA. SHE'S HAD A G.I. BLEED FROM GASTRITIS IN HER MID 60s AND CAN NO LONGER TAKE NSAIDs. AND SHE HAS NEEDED STRONGER ANALGESICS TO CONTROL THE KNEE PAIN. INCLUDING OCCASIONAL OPIATES FOR ACUTE EXACERBATIONS. WHAT'S WRONG WITH THIS ALL TOO FAMILIAR PICTURE? THE PATIENT IS OBVIOUSLY SUFFERING FROM HAVING BROKEN DOWN INTO SEPARATE [INAUDIBLE] AND EACH OF HER PROBLEMS IS TREATED AS A SEPARATE DISEASE AND THE RESULTING POLYDIAGNOSIS AND POLYPHARMACY HAS CREATED AN ADDITIONAL LAYER OF DRUG INDUCED PA THROLG. AND FAILURE TO UNDERSTANDING THE IMPORTANCE OF SEEING THIS PATIENT AS A WHOLE PERSON HAS LED TO TREATING AS A FRAGMENTED DISEASE FOCUSED MODEL THAT ENCOURAGES RELIANCE ON PHARMACOLOGICAL CONTROLLING DIFFERENT DISEASES RATHER THAN RESTORING HEALTH. SO THIS IS A SERIOUS PROBLEM. NOW, THE ANSWER TO THIS CLEARLY IS POINTING THE ARROW BACKWARDS [INAUDIBLE] BUT THAT'S NOT EASY TO DO. WE HAD A LOT OF TALK, I WOULD SAY IN THE LAST 10 YEARS, ABOUT PERSONALIZED MEDICINE, PRECISION MEDICINE, INDIVIDUALIZED MEDICINE, AND WHAT HAS HAPPENED IS THAT AT THE BEGINNING, THE IDEA OF PERSONALIZED MEDICINE WAS THE WHOLE PERSON, BUT GRADUALLY THIS IDEA HAS GOTTEN PULLED TOWARDS PRECISION END OF THINGS, TOWARDS USING DRUGS, FOR EXAMPLE, IN A MORE AND MORE PRECISE WAY BASED ON GENOMIC MARKERS, FOR EXAMPLE. SO THE WORD "PERSONALIZED" AND "PRECISION" HAVE BEEN USED KIND OF IN AN INTERCHANGEABLE WAY, WHICH HAS KIND OF LEFT THE WHOLE PERSON A LITTLE BIT BEHIND, AND WE'RE CONCERNED ABOUT THAT. NOW, NOT TO SAY THAT INTEGRATION AND SYNTHESIS HAVE NOT PLAYED A ROLE IN RESEARCH. OF COURSE THEY HAVE. AND THERE IS NOW THE GROWING FIELD OF SYSTEMS BIOLOGY, FOR THAM, FOR EXAMPLE, THAT LOOKING AT THE INTERACTION BETWEEN DIFFERENT SYSTEMS IN THE BODY AND ALSO, FOR EXAMPLE, GENOME-WIDE ASSOCIATION STUDIES THAT REALLY UNDERSTAND THAT IT'S NOT JUST ONE GENE, ONE DISEASE. A LOT OF TIMES YOU HAVE CLUSTERS OF GENES THAT YOU LOOK AT TOGETHER TO INFLUENCE MULTIPLE BODY SYSTEMS. BUT I WOULD ASK YOU TO CONSIDER, IF YOU WERE TO ASK SOMEBODY WHO DOES YOGA, IS IT POSSIBLE THAT HOW YOU BREATHE INFLUENCES YOUR DIGESTIVE SYSTEM? I WOULD SAY A LOT OF TIMES PEOPLE WOULD SAY YEAH, PROBABLY, PEOPLE WHO DO YOGA OR PRACTICE MEDITATION, BUT IF YOU DO A PUBMED SEARCH FOR ANYTHING RESPIRATORY WITH ANY GASTROINTESTINAL, YOU FIND NOTHING. AND WHY IS THAT? BECAUSE, YOU KNOW, GASTROINTESTINAL AND PULMONARY ARE IN SEPARATE SYSTEMS AND THEY'RE STUDIED BY DIFFERENT PEOPLE, THEY'RE FUNDED BY DIFFERENT INSTITUTES AND YOU KNOW, THEY'RE IN DIFFERENT GROUPS OF SILOS ESSENTIALLY. SO WE HAVE A LONG WAY TO GO BEFORE WE CAN TRULY INTEGRATE AND UNDERSTANDING THE BODY AS A WHOLE IN NOT ONLY THE BODY BUT ALSO THE PSYCHOSOCIAL ASPECTS OF HUMAN FUNCTIONING. THERE'S AN INTERESTING PIECE OF THIS THAT WE'RE CURRENTLY VERY INTERESTED IN AT NCCIH WHICH IS THE CONCEPT OF INTERRESECTION, THE RELATIONSHIP OF HOW THE NERVOUS SYSTEM PERCEIVES, INTERPRETS AND INTEGRATES SIGNALS FROM WITHIN ITSELF. HOW DO YOU SENSE, FOR EXAMPLE, WHEN YOU'RE THIRSTY, WHEN YOU'RE HUNGRY. WHAT ARE THE INTERNAL BODY SENSATIONS THAT YOU RECEIVE THAT MAY OR MAY NOT BE CONSCIOUS BUT THAT ARE INTEGRATED AND CAN INTERFACE A LOT OF TIMES WITH EMOTIONS, AND HOW DOES THE BRAIN INTERACT WITH ALL THE DIFFERENT ORGAN SYSTEMS? THIS IS A VERY IMPORTANT AREA OF BASIC RESEARCH THAT WE ARE IN THE PROCESS OF PROMOTING AT NCCIH. THE INTERESTING THING TO THINK ABOUT, THOUGH, IS THE BRAIN IS NOT NECESSARILY AT THE CENTER OF THINGS, RIGHT? YOU COULD THINK OF A GUT-CENTRIC, HERE LIKE ON THE LEFT, OR EVEN A MUSCULOSKELETAL-CENTRIC, RIGHT, WAY OF VIEWING THINGS. OUR UNDERSTANDING OF THE GUT HAS BEEN REVOLUTIONIZED BY OUR UNDERSTANDING OF THE MICROBIOME. WE DON'T KNOW THAT WHAT GOES OFTEN INSIDE OUR GUTS, A CONVERSATION THAT HAPPENS ALL THE TIME BETWEEN FOODS THAT WE EAT AND THE MICROBES THAT ARE INSIDE US AND THE, FOR EXAMPLE, PROCESSES, INFLAMMATORY PROCESSES THAT COULD OCCUR IN THE G.I. TRACT CAN INFLUENCE WHAT GOES ON IN OUR BRAINS. SO THIS IS VERY MUCH AN AREA IN EVOLUTION. SO IT'S VERY IMPORTANT TO THINK ABOUT THIS INTEGRATION AS BEING VERY MULTIFACETED. IT'S INTERESTING TO THING ABOUT HOW THESE THREE DIFFERENT WAYS TO THINK ABOUT THE BODY, HOW THEY MAP OUT ON TO OUR DIETARY, PSYCHOLOGICAL AND PHYSICAL TYPES OF INTERVENTIONS. SO JUST TO SUMMARIZE THE INTEGRATION PART, ADVANCING RESEARCH ON THE WHOLE PERSON AS WELL AS THE INTEGRATION OF COMPLEMENTARY AND CONVENTIONAL CARE. SO YOU SEE THAT WE'RE EXPANDING THE MEANING OF INTEGRATION BEYOND BASICALLY JUST A CLINICAL DEFINITION. WE REALLY WANT TO GO INTO THE BASIC SCIENCE, INTO UNDERSTANDING THE BASIC PHYSIOLOGY OF HOW DO PEOPLE FUNCTION AS A WHOLE. AND ALSO PATHOPHYSIOLOGY, UNDERSTANDING HOW DISEASE HAPPENS BUT IMPORTANTLY, HOW HEALTH HAPPENS. AND THAT GETS US TO THE NEXT LETTER, WHICH IS H. SO I WOULD INVITE YOU FOR A SECOND TO CONSIDER THESE TWO PLANTS. THE ONE ON THE LEFT LOOKS HEALTHY ENOUGH, AND THE ONE ON THE RIGHT LOOKS LIKE IT GOT SOME SORT OF BAD DISEASE THAT'S GOING TO NEED ATTENTION. BUT WHAT BL THE ONE IN ABOUT THE ONE IN T HE MIDDLE? IT DOESN'T LOOK TOTALLY HEALTHY, BUT IT LOOKS LIKE IF IT GOT BETTER CARE PERHAPS, A LITTLE BIT MAYBE LESS WATER OR MORE SUNLIGHT, IT MIGHT BE ABLE TO GO BACK TO BEING HEALTHY AGAIN, RIGHT? YOU HAVE A SENSE FROM LOOKING AT THESE PLANTS THAT THE TRANSITION BETWEEN HEALTH AND WHAT I'VE CALLED UNHEALTH, IT'S ACTUALLY A WORD, YOU CAN LOOK IT UP IN THE DICTIONARY, IT NOT USED VERY MUCH, WE TALK ABOUT UNHEALTHY BUT WE DON'T TALK ABOUT A STATE OF UNHEALTH, WHICH I THINK IS AN INTERESTING CONCEPT THAT MIGHT BE WORTH DEVELOPING SOME MORE. BUT THE TRANSITION BETWEEN UNHEALTH AND DISEASE SEEMS A LITTLE BIT LESS REVERSIBLE. ONCE YOU'VE CROSSED OVER INTO DISEASE, IT'S LESS EASY TO GO BACK IN THE OPPOSITE DIRECTION UNLESS YOU DO SOMETHING LIKE TREAT IT LIKE IN THIS CASE WITH PROBABLY A FUNGICIDE. NOW, WHAT ABOUT PEOPLE? THE SAME THING WITH PEOPLE, RIGHT? THERE IS A TRAN SILKS BETWEEN HEALTH AND DISEASE THAT IS NOT ALL OR NONE. A LOT OF TIMES YOU HAVE WHAT WE CALL PREDISEASE. AN EXAMPLE OF THIS WOULD BE DIABETES. SO BEFORE FRANK DIABETES HAPPENS, YOU HAVE A PERIOD OF TIME WHERE THE BLOOD SUGAR IS STARTING TO GO UP A LITTLE BIT, AND A LOT OF TIMES, THIS IS PRECEDED BY A PERIOD OF WEIGHT GAIN. THAT RESULTS FROM POOR DIET, AND THIS BEHAVIORAL PHASE IS REVERSIBLE. WE KNOW THAT IF PEOPLE WILL CHANGE AND PAY ATTENTION TO THEIR DIET AND LOSE WEIGHT, A LOT OF TIMES, ESPECIALLY I'M TALKING ABOUT TYPE 2 DIABETES HERE, OF COURSE, THAT THE GLUCOSE AND METABOLIC ABNORMALITIES CAN GO BACK TO NORMAL. SO THE PROCESS OF PRE-DISEASE, THE TRANSITION BETWEEN BEHAVIORAL DYSFUNCTION AND PREDISEASE IN THIS CASE IS RYE VERSIBLE. WE KNOW THIS. AND THE LINE BETWEEN PREDISEASE AND DISEASE IS IN DEBATE. IN THE CASE OF DIABETES, THERE ARE ARGUMENTS ABOUT HOW QUICKLY SHOULD YOU START TREATING WITH GLUCOSE LOWERING AGENTS? ONCE YOU START THAT, ARE YOU KIND OF GIVING UP? A LOT OF TIMES PATIENTS WILL NOT NECESSARILY ADHERE TO THEIR DIETS IF THEIR BLOOD SUGAR COMES INTO GOOD CONTROL WITH THE DRUGS. SO WHEN DO YOU START THAT? THERE'S A DEBATE ABOUT THIS, SHOULD YOU BE MOVING THIS LINE FURTHER TO THE LEFT AND ACTUALLY START TREATING PREDISEASE WITH DRUGS TO PREVENT COMPLICATIONS OF DIABETES. AND THERE'S GOOD ARGUMENTS TO BE MADE FOR THAT. SO THIS IS AN AREA WHERE WE REALLY FEEL LIKE THIS IS WORTH PAYING ATTENTION. NOW OF COURSE WE KNOW THAT DIABETES DOES NOT HAPPEN OFTEN BY ITSELF. A POOR DIET AND WEIGHT GAIN VERY OFTEN ARE ASSOCIATED WITH CHANGES IN LIPIDS, CARDIOVASCULAR DISEASE THAT HAPPENS AT THE SAME TIME, WE CALL THESE CO-MORBID. WE THEY HAPPEN VERY MUCH IN THE SAME INDIVIDUALS. AND VERY OFTEN, A SEDENTARY LIFESTYLE IS PART OF THE PROBLEM. THERE'S NOT ENOUGH PHYSICAL ACTIVITY, NOT ENOUGH EXERCISE, AND THIS CONTRIBUTES TO THE WEIGHT GAIN, CONTRIBUTES TO THE MED METABOLIC DIFFICULTIES. IN ADDITION TO THAT SEDENTARY LIFESTYLE AND WEIGHT GAIN WILL THEN PREDISPOSE TO MUSCULOSKELETAL PROBLEMS. STRESS ON THE JOINTS. DEGENERATIVE JOINT PROBLEMS AND PAIN. AND THEN TO CAP IT OFF, WE ALSO KNOW THAT PSYCHOLOGICAL STRESS, POOR SLEEP HABITS, COME ALONG WITH ALL OF THIS. LACK OF EXERCISE AND CHRONIC PAIN ESPECIALLY, MUSCULOSKELETAL PAIN FEEDS -- CAUSES FURTHER STRESS WHICH COMPOUNDS THE WHOLE PROBLEM. IT'S VERY DIFFICULT TO GET MOTIVATED, TO EXERCISE WHEN YOU HAVEN'T HAD A GOOD NIGHT'S SLEEP. WE ALL KNOW THIS. AND OF COURSE YOU'RE GOING TO GO FOR THAT PLATE OF COOKIES IN THE AFTERNOON, RIGHT, IF YOU'RE EXHAUSTED. SO THE STRESS AND SLEEP DIFFICULTY WILL COMPOUND THIS WHOLE ISSUE AND SO WHAT WE CALL THESE CO-MORBID CONDITIONS ARE NOT HAPPENING JUST COINCIDENTALLY WITH EACH OTHER. THE INTERESTING THING WE'RE ALSO FIND OUT FROM THE PHYSIOLOGICAL POINT OF VIEW, AND OF COURSE AS I SAID BEFORE, WE TEND TO TREAT -- THE PROBLEM IS, WE TEND TO TREAT ALL OF THESE PROBLEMS AS THOUGH THEY WERE INDEPENDENT WITH ALL THESE INDEPENDENT DRUGS. BUT WHAT WE KNOW IS THAT THESE PROBLEMS ACTUALLY SHARE COMMON PATHOPHYSIOLOGICAL ELEMENTS AND INFLAMMATION IS ONE OF THEM. WE'VE MADE A LOT OF PROGRESS IN THE LAST, SAY, 20 YEARS OR SO IN UNDERSTANDING THAT INFLAMMATION IS NOT A COMPARTMENTALIZED PROBLEM. WE CAN HAVE A SORT OF GLOBAL INFLAMMATORY BURDEN THAT BECOMES SYSTEMIC AND THAT CAN ACCUMULATE IN THE ADDITIVE FROM DIFFERENT SOURCES, INCLUDING FROM OBESITY, INCLUDING FROM CARDIOVASCULAR DISEASE, INCLUDING FROM STRESS. WE KNOW THAT LACK OF SLEEP AND CHRONIC STRESS INCREASES SYSTEMIC INFLAMMATION. AS WELL AS STRESS AND INFLAMMATION COMING FROM MUSCULOSKELETAL CONDITIONS. THAT CAN ALSO INCREASE THE INFLAMMATORY BURDEN. SO IF WE GO BACKWARDS A STEP AND GO BACK TO WHAT MAY HAVE LED TO THIS, A COMBINATION OF PSYCHOLOGICAL STRESS, SEDENTARY LIFESTYLE, WHAT CAN WE DO ABOUT THIS? IMPORTANTLY, WHAT CAN WE DO TO PREVENT ALL THESE DISEASES FROM HAPPENING? SO IN SO ESPECIALLY WHEN CAUGHT EARLY, AT THE PRE-DISEASE STAGE, THERE IS THE POTENTIAL FOR REVERSING A LOT OF THESE CONDITIONS. SELF CARE INTERVENTIONS AND DIETARY, PSYCHOLOGICAL AND PHYSICAL INTERVENTIONS, ALL THE ONES THAT I PUT ON THAT SORT OF DIAGRAM AT THE BEGINNING, MANY OF THESE CAN SORT OF COMPLEMENT EACH OTHER TO HELP THE PERSON ARRIVE AT A GREATER OVERALL HEALTH BY SIMPLY IMPROVING AND SUPPORTING THE BEHAVIORAL CHANGES. SO EVEN THOUGH ONCE A PERSON HAS CROSSED OVER NOOL THE OVER INTO THE DISEA SE -- [INAUDIBLE] TO PREVENT FURTHERMORE FURTHER MORBIDITY, BUT HAVING SAID THAT, THE BEHAVIORAL INTERVENTIONS ARE IMPORTANT THROUGHOUT THIS ENTIRE PROCESS. SO WHAT IS WHOLE PERSON HEALTH? WE THINK THAT WHOLE PERSON HEALTH, THE WAY TO SUMMARIZE IT IS SUPPORTING THE HEALTH OF INDIVIDUALS IN MULTIPLE INTERCONNECTED DOMAINS, INCLUDING SOCIAL, PSYCHOLOGICAL AND PHYSICAL, AND INCLUDING INTEGRATION ACROSS ALL OF THE BODY SYSTEMS, AND THAT THE BI-DIRECTIONAL HEALTH TO DISEASE SPECTRUM HERE IS REPRESENTED WITH THIS ARROW IN TERMS OF SUPPORTING PROCESSES THAT RESTORE HEALTH. WE PAY A LOT OF ATTENTION TO DISEASE. WHAT WE DON'T KNOW SO MUCH ABOUT IS WHAT HAPPENS EXACTLY WHEN SOMEBODY GETS HEALTHIER. WHAT IS THE PROCESS OF THAT? AND OF COURSE BECOMING HEALTHIER CAN OCCUR IN DIFFERENT PLANES. NOT NECESSARILY ALL AT THE SAME TIME. AND OUR GRAPHICS DEPARTMENT HAS PROVIDED ME WITH THIS WONDERFUL SLOID THAT KIND OF SLIDE THAT INTEGRATES THIS WHERE CAN YOU HAVE PLANES. ON THE PSYCHOLOGICAL PLANE, SOMEBODY MIGHT MAKE A LOT OF PROGRESS ON HAVING MORE SOCIAL CONNECTEDNESS, FOR EXAMPLE, EMOTIONAL WELL-BEING AND RESILIENCE, AND AT THE SAME TIME, OR AT DIFFERENT TIMES, SORT OF IMPROVING, FOR EXAMPLE, THEIR PHYSICAL WELL-BEING AND PHYSIOLOGICAL HEALTH BY IMPROVING THEIR DIET OR GETTING SOME EXERCISE, AND THAT THE TWO PLANES ARE INTERRELATED AND SO THIS KIND OF SHOWING THAT YOU REALLY HAVE TO CONSIDER BOTH, BUT IT DOES BECOME QUITE COMPLEX, SO THE QUESTION IS, HOW DO YOU MEASURE THIS? WE SPEND A LOT OF ATTENTION ON NEGATIVE OUTCOMES. THESE ARE THE THINGS THAT WE MEASURE IN OUR STUDIES: PAIN, FATIGUE, DISABILITY, FUNCTIONAL IMPAIRMENT. WHAT ABOUT THE POSITIVE OUTCOMES? WHAT HAPPENS WHEN YOU GO BACK TOWARDS HEALTH, PHYSICAL AND EMOTIONAL WELL-BEING, FOR EXAMPLE, RESILIENCE AND STAMINA, HOW DO YOU MEASURE THIS? AT NCCIH, WE RECENTLY ISSUED AND JUST ARE FUNDING SOME APPLICATIONS ON MEASUREMENTS OF EMOTIONAL WELL-BEING, AND THERE IS A TRANS-NIH EFFORT GOING ON RIGHT NOW ON DEVELOPING MEASURES OF RESILIENCE. SO THE WHOLE IDEA OF HEALTH RESTORATION, WE FEEL IS AN AREA WHICH IS VERY, VERY MUCH IN NEED OF MORE RESEARCH, AND THAT WE NEED TO DEVELOP THAT SENSE OF UNDERSTANDING THE BASIC PHYSIOLOGY OF RESTORATION, UNDERSTANDING THE PHYSIOLOGICAL CHANGES THAT HAPPEN WHEN PEOPLE GO BACK TO HEALTH. WHICH BRINGS US BACK TO MECHANISMS BECAUSE ULTIMATELY WE REALLY WANT TO UNDERSTAND HOW THIS HAPPENS. THERE'S A FAIR AMOUNT OF BASIC RESEARCH MAINLY IN ANIMAL MODELS AND EVEN CELLULAR MODELS ON BASIC MECHANISMS OF REPAIR. RECOVERY, REGENERATION, RESTRUCTURING, ALL THESE WONDERFUL WORDS THAT START WITH R. BUT THIS TENDS TO BE AT THE VERY BASIC CELLULAR LEVEL. WE REALLY NEED TO EXPAND OUR UNDERSTANDING OF HOW THIS OCCURS AT A WHOLE PERSON LEVEL AND ESPECIALLY HOW, FOR EXAMPLE, PSYCHOLOGICAL RESILIENCE AND PHYSIOLOGICAL RESILIENCE, HOW DO THEY RELATE TO EACH OTHER? THEY'RE PROBABLY NOT SEPARATE, RIGHT? IT MAKES SENSE. SO WE NEED TO UNDERSTAND THIS BETTER. AND SO AS MUCH AS IT IS IMPORTANT TO UNDERSTAND WHAT WE CALL NEGATIVE MECHANISMS, FOR EXAMPLE, INFLAMMATION, DEGENERATION, THROMBOSIS, NEOPLASIA, ET CETERA, WE ALSO WANT TO UNDERSTAND THE POSITIVE MECHANISMS AS WELL. WHAT IS IT THAT SUPPORTS A RETURN TO HEALTH? A VERY INTERESTING EXAMPLE THAT WE ARE GOING THROUGH THIS IN REALTIME RIGHT NOW IS WITH COVID-19, RIGHT? WE KNOW THAT PEOPLE WHO CONTRACT THE VIRUS AND HAVE AN ACUTE RESPIRATORY INFECTION, SOME OF THEM, MANY OF THEM GO BACK TO HEALTH AND THEY'RE FINE. BUT A LOT OF THEM DON'T. SO THERE ARE A LOT OF VIRAL -- ESPECIALLY COVID-19, THIS KIND OF LONG TAIL OF SYMPTOMS THAT PERSISTS. AND WE KNOW THAT THERE ARE SYMPTOMS INCLUDING THROMBOTIC PROBLEMS, INFLAMMATORY PROBLEMS THAT DON'T GO AWAY. AND SO HOW DO WE UNDERSTAND BETTER HOW TO SUPPORT THE RECOVERY AND RETURN TO HEALTH? IN THE OLD DAYS, IF YOU READ NOVELS, FOR EXAMPLE, IN 19TH CENTURY OR BEFORE THAT, AND YOU READ STORIES OF PEOPLE BEING SICK, THERE WAS A LOT OF ATTENTION PAID TO WHAT WAS CALLED THE CONVALESCENT PERIOD, RIGHT? THERE WERE NO ANTIBIOTICS AT THE TIME, SO IF YOU GOT PNEUMONIA, WELL, YOU HAD TO PAY A LOT OF ATTENTION IF YOU WERE LUCKY ENOUGH TO SURVIVE THE ACUTE PHASE, BACTERIAL PHASE, PEOPLE KNEW THAT UNLESS -- IF YOU DIDN'T PAY ATTENTION, PEOPLE GOT RELAPSES AND THEY DID NOT -- THEY HAD TO GRADUALLY REBUILD THEIR HEALTH AS AFTERWARDS, IN THE FOLLOWING WEEKS AND MONTHS AFTER AN ACUTE ILLNESS. PEOPLE KNEW THIS BECAUSE THEY COULD OBSERVE THAT PEOPLE WHO DIDN'T DO THAT, OFTEN THEY RELAPSED OR THEY DIED. NOW, SINCE WE STARTED DEVELOPING THESE WONDERFUL ESPECIALLY ANTIBIOTICS FOR EXAMPLE, WE DON'T PAY MUCH ATTENTION TO THEM. WE THINK THAT ONCE THE BACTERIA ARE KILLED, WE'RE GOING TO GO BACK TO HEALTH AND YOU SEE PEOPLE TAKING A COURSE OF ANTIBIOTICS AND GOING RIGHT BACK TO WORK AND GOING RIGHT BACK TO PLAYING SPORTS. BUT A LOT OF TIMES WHAT HAPPENS IS, THEY GET SYMPTOMS, THEY DON'T FEEL QUITE RIGHT, THEY FEEL TIRED, THEY'RE FATIGUED, SOMETIMES THEY GET ANOTHER INFECTION AFTER THAT. THE IMMUNE SYSTEM HASN'T QUITE RESET. AND HEALTH HAS NOT FULLY BEEN RESTORED. AND SO THE IDEA THAT HEALTH RESTORATION IS IMPORTANT, AS WELL AS TREATING THE DISEASE, AND HEALTH RESTORATION IS IMPORTANT AS WELL AS PREVENTING THE DISEASE. A LOT OF OUR PREVENTIVE MEDICINE EFFORTS ARE FOCUSED GOING TOWARDS DISEASE, PREENING PREVENTING THIS, BUT WE NEED TO UNDERSTAND BET ARE HOW TO TER HOW TO GO BACK THE OTHE R WAY. SO TO SUMMARIZE, H IN NCCIH INCLUDES ADDRESSING HEALTH PROMOTION AND RESTORATION, RESILIENCE, DISEASE PREVENTION, AND SYMPTOM MANAGEMENT. THIS GETS US BACK TO PAIN. I MENTIONED AT THE VERY BEGINNING THAT PAIN WAS A SYMPTOM, MANAGING SYMPTOMS SUCH AS PAIN OR ANXIETY OR STRESS WAS VERY, VERY IMPORTANT IN NCCIH'S PREVIOUS STRATEGIC PLAN AND REMAINS SO. WHAT WE HAVE DONE IS WE'VE KIND OF FOLDED IT IN TO THIS ENTIRE SORT OF WHAT WE CALL THE HEALTH DISEASE CONTINUUM, BECAUSE MANAGING SYMPTOMS IS PART OF THIS, THE WHOLE WAY. MANAGING SYMPTOMS IS IMPORTANT, WHETHER ONE IS DEALING WITH AN ACUTE ILLNESS, CHRONIC ILLNESS, RELAPSING OF A CHRONIC ILLNESS OR END STAGE DISABILITY FOR EXAMPLE. IT ALWAYS IMPORTANT TO MANAGE SYMPTOMS, IT'S ALWAYS IMPORTANT TO HELP PEOPLE COPE PSYCHOLOGICALLY, PHYSICALLY. SO -- BUT WE HAVE INCLUDED IT IN THE HEALTH DISEASE CONTINUUM, HEALTH CONTINUUM THAT WE CALL IT. SO AS YOU CAN SEE THAT THOSE THREE ELEMENTS, COMPLEMENTARY AND INTEGRATIVE HEALTH, ARE SORT OF -- HAVE BEEN MODIFIED JUST A LITTLE BIT COMPARED WITH WHAT WE HAD BEFORE, WHERE WE HAD MAINLY A FOCUS ON MIND AND BODY AND NATURAL PRODUCTS, NOW WE HAVE A BIT OF A MORE FULLER PICTURE THAT INCLUDES STILL MIND AND BODY AND NATURAL PRODUCTS BUT IS MORE KIND OF SITUATED IN A WHOLE PERSON HEALTH FRAMEWORK. AN THESE THREE ELEMENTS HAVE BECOME THE THREE MAIN OBJECTIVES OF OUR NEW STRATEGIC PLAN. NOW, I WANT TO TALK ABOUT WOMEN'S HEALTH FOR A LITTLE BIT, BECAUSE WE DO FUND A FAIR AMOUNT OF RESEARCH THAT IS RELEVANT TO THE HEALTH OF WOMEN AS YOU CAN IMAGINE. WOMEN ARE BIG UTILIZERS OF COMPLEMENTARY INTERVENTIONS AND TREATMENTS AND PRACTICES. SO WE'VE DONE -- JUST SHOW YOU A LITTLE BIT A KIND OF LITTLE WORK CLOUD TO SHOW SOME OF THE COMMON THEMES THAT ARE -- WHEN WE'VE SEARCHED OUR RESEARCH PORTFOLIO ABOUT RESEARCH THAT GET UNDER A CATEGORY OF RESEARCH IN WOMEN'S HEALTH. WE FOUND THESE TYPES OF THEMES THAT CAME BACK SO YOU CAN SEE STRESS HERE, YOU SEE BOTANICALS, YOGA, MBSR, ESTROGEN, CANCER, ENDOMETRIOSIS, INFLAMMATION. SO, YOU KNOW, YOU CAN SEE THAT THERE ARE A LOT OF THEMES THAT ARE RELEVANT TO ALL OF THE -- WHAT I TALKED ABOUT ALREADY IN THIS TALK. BUT WHAT WE WANT TO MOVE FORWARD IS TO REALLY ENCOURAGE RESEARCH THAT INTEGRATES ALL OF THESE VARIOUS COMPONENTS IN A WHOLE PERSON CONTEXT. I'M JUST GOING TO GIVE YOU A COUPLE OF EXAMPLES. THESE ARE STUDIES THAT WE FUNDED IN THE PAST, I BELIEVE, TWO YEARS, JUST EXAMPLES OF FEASIBILITY OF YOGA IN SEDENTARY AFRICAN AMERICAN WOMEN, BOTANICAL DERIVED PROGESTINS, E-HEALTH EDUCATION TO IMPROVE MEDICATION ADHERENCE AMONG BREAST CANCER SURVIVORS, PHYSICAL ACTIVITY AS THERAPEUTIC INTERVENTION IN ENDOMETRIOSIS, E-HEALTH MINDFUL MOVEMENT AND BREATHING TO IMPROVE GYNECOLOGICAL OUTCOMES, YOU CAN SEE THERE'S A LOT OF VARIETY AND WE'RE VERY EXCITED AND ENTHUSIASTIC TO CONTINUE ON THIS -- PURSUING A LOT OF THESE. I'M GOING TO TALK A LITTLE BIT ABOUT SEX AS A BUY LOGICAL VARIABLE BECAUSE THIS IS SUCH AN IMPORTANT TOPIC AND I KNOW THIS HAS BEEN CHAMPIONING VERY RIGHTFULLY SO BY THE OFFICE OF RESEARCH OND WOMEN'S HEALTH, WE ARE PAYING A LOT OF ATTENTION TO THIS. AT ALL LEVELS INCLUDING REVIEW, INCLUDING CLARIFYING THE EXPECTATIONS WITH THE COLLAR FIX LETTERS THAT WE SEND, WE ADDRESS RECRUITMENT CHALLENGES AND ALL OF OUR COOPERATIVE AGREEMENTS, ALL OF OUR LARGE CLINICAL TRIALS RIGHT NOW, EVERY SINGLE ONE IS ADDRESSING SEX DIFFERENCES IN THEIR ANALYSIS, IN THEIR DISCIPLINE ANALYSIS. WE HAVE NOT YET LOOKED INTO THIS, WE HAVE NOT YET FUNDED ANY SUPPLEMENTS TO SPECIFICALLY INCLUDE SEX AS A BIOLOGICAL VARIABLE, BUT I REALLY WANT TO EXPLORE THAT AS TO WHY THAT WAS NOT THE CASE, SO WE'RE GOING TO BE LOOKING INTO THAT SOON. NOW, WE HAVE A LOT OF FEMALE GRANTEES. NCCIH IS NOT SUFFERING IN THIS AREA AT ALL. YOU CAN SEE THAT A LOT OF WOMEN ARE INTERESTED IN THIS AREA, WE HAVE A LOT OF WONDERFUL WOMEN PRINCIPAL INVESTIGATORS, AND SO THIS IS AN AREA WHERE WE FEEL VERY BLESSED THAT WE DON'T HAVE ANY DIFFICULTIES WHATSOEVER RECRUITING, FINDING WOMEN SCIENTISTS. AND YOU KNOW, IT REFLECTS A LITTLE BIT THE TOPIC. YOU KNOW WOMEN ARE INTERESTED IN THIS. SO I WILL PAUSE HERE FOR QUESTIONS AND I ALSO WANT TO GIVE OUR CONTACT INFORMATION IF ANY OF YOU ARE INTERESTED. SO I'M GOING TO STOP SHARING. >> THANK YOU VERY MUCH, DR. LANGEVIN, FOR THE INCREDIBLE WHIRLWIND PRESENTATION. JUST A FABULOUS PERSPECTIVE ON THE HEALTH OF WOMEN AND THE WHOLE PERSON HEALTH. I REMEMBER THAT CONVERSATION, THAT FIRST CONVERSATION WE HAD WHEN YOU FIRST GOT HERE IN YOUR OFFICE IN DEMOCRACY 2 IN A BUILDING WE HAVEN'T BEEN INTO FOR 6 MONTHS, AND JUST THE AMOUNT OF ALIGNMENT AND HARMONY BETWEEN WHAT I HEARD YOU SAYING AS WHERE YOU WERE GOING, AND I'M JUST REALLY THRILLED TO SEE THE FRUITION OF THAT VISION. I'M GOING TO GO AHEAD AND TAKE A LOOK IN THE CHAT AND SEE IF THERE ARE QUESTIONS. SARAH IS MONITORING. DO WE HAVE ANY QUESTIONS IN THE CHAT? >> DR. ROBINSON JUST ASKED A QUESTION. >> CAN DR. ROBINSON UNMUTE OR SHALL WE GO AHEAD AND JUST READ THAT? >> HELLO. GOOD MORNING. I CAN UNMUTE. THAT WAS A FANTASTIC PRESENTATION, AND AS I WAS LISTENING TO IT, I WAS THINKING ABOUT ALL OF THE RESIDENTS, POSTDOCS AND STUDENTS WE WORKED WITH, ANY ADVICE ON HOW TO MENTOR OTHERS TO START THINKING THIS WAY FROM AN EARLY STAGE WHEN THEY'RE STILL LEARNING? >> THIS IS SOMETHING I THINK ABOUT A LOT. WHERE I WAS IN MY PREVIOUS JOB AT HARVARD MEDICAL SCHOOL, WE ADDRESSED THIS PROBLEM AT EVERY SINGLE LEVEL. THE FIRST STEP IS, OF COURSE, MEDICAL STUDENTS RIGHT WHEN THEY COME IN, FIRST DAY. AND IN FACT, ONE OF OUR -- OUR DIRECTOR OF EDUCATION, WHO STARTED A MANDATORY KIND OF COURSE IN MANAGING THEIR OWN STRESS FOR THE STUDENTS THEMSELVES, WE FIGURED THAT IF THEY DRINK THEIR OWN KOOL-AID AND GET THAT, BECAUSE THEY KNOW, THEY'RE STARTING MEDICAL SCHOOL, THEY THINK EVERYTHING IS GOING TO BE FINE AND PRETTY SOON THE WORLD COMES CRASHING DOWN ON THEM, THEY'D GET PRETTY STRESSED OUT, SO TO GIVE THEM THE TOOLS RIGHT FROM THE BEGINNING, EMPHASIZED HOW IMPORTANT IT IS FROM THEIR OWN HEALTH WELL-BEING, GIVE THEM SOME EXPERIENTIAL INSTRUCTION AT THE SAME TIME TEACHING THEM HOW PHYSIOLOGICALLY THIS IS IMPORTANT FOR THE CARDIOVASCULAR SYSTEM, THEY TEACH THIS AT THE SAME TIME THAT THEY TEACH STRESS, THEY TEACH IT THE SAME TIME THEY TEACH ABOUT BLOOD PRESSURE AND STUFF LIKE THAT. SO THERE IS A WAY TO INTRODUCE IT INTO THE CURRICULUM. IT'S VERY HARD, THOUGH, BECAUSE EVERY TIME YOU INTRODUCE SOMETHING IN THE CURRICULUM, YOU HAVE TO TAKE SOMETHING OUT. VERY, VERY DIFFICULT. FOR RESIDENTS, IT'S EVEN MORE IMPORTANT. THEY ARE -- WE FIND THAT AT THAT POINT, THEY ALMOST HAVE NO TIME TO ABSORB NEW INFORMATION. SO IT VERY, VERY IMPORTANT TO HAVE IT SO THAT IT BEFORE THEY HIT THE WARD, BUT IT'S NOT TOO LATE. THERE ARE A LOT OF PROGRAMS THAT CAN BE TAILORED TO RESIDENTS IN ORDER TO HELP THEM TO MANAGE THEIR PATIENTS BETTER, TO UNDERSTAND HOW DO YOU DEAL WITH SOMEBODY WHO HAS ALL THESE COMPLEX PROBLEMS THAT, YOU KNOW, THEY'RE SO COMPLICATED. WELL, THEY'RE RELATED. SO TEACH THEM THAT INTEGRATED THINKING AND LATER ON, THERE ARE FELLOWSHIPS AND THEN, YOU KNOW, THAT PEOPLE CAN DO. THERE ARE INTEGRATIVE MEDICINE FELLOWSHIPS, QUITE A FEW OF THEM ACTUALLY THROUGHOUT THE COUNTRY WHERE PEOPLE CAN LEARN MORE ABOUT THIS AS THEY WANT TO ADD THIS TO THEIR SIMPLE REPERTOIRE. IT'S A LONG PROCESS TO INTEGRATE THIS. >> THANK YOU. >> HELENE, THERE'S A QUESTION FROM ROGER FILLINGIM. ROGER, CAN YOU UNMUTE? >> SURE. THANK YOU. AND DR. LANGEVIN, THANK YOU FOR THAT OUTSTANDING PRESENTATION. IT'S SO NICE TO HEAR THAT PERSPECTIVE. AND AS YOU GO THROUGH THE LETTERS OF THE CENTER NAME NOW, IT MAKES ME THINK THAT MANY APPLICATIONS THAT PREVIOUSLY WOULDN'T HAVE BEEN CONSIDERED MISSION-RELEVANT MIGHT NOW BE MISSION-RELEVANT, AND ARE YOU ANTIPATING OR ANTICIPATING OR SEEING AN INCREASE IN NUMBER OF APPLICATIONS AND IF SO, HOW DO YOU HANDLE THIS? >> HOW DO WE LAN DELL THIS HANDLE THIS WI TH OUR VERY SMALL BUDGET. SO FOR US, THE KEY THING IS TO DEVELOP PARTNERSHIPS. WE REALIZE THAT -- AND WE ALREADY HAVE SOME VERY STRONG PARTNERSHIPS WITH NIA, FOR EXAMPLE. WE'VE BEEN WORKING WITH NIA, WHERE WE HAVE AN AFFINITY THERE BECAUSE NIH IS REALLY INTERESTED IN LOOKING AT FIRST OF ALL THE HEALTH SPAN, AND THAT KIND OF HAVE ALREADY AN INTEGRATIVE FOCUS, BUT WE ALSO ARE VERY INTERESTED IN COLLABORATING WITH OTHER INSTITUTES THAT ARE MORE RESTRICTIVE BUT THAT WITHIN THEM, FOR EXAMPLE, NHLBI OR NIDDK, BUT WITHIN THESE INSTITUTES, YOU HAVE GROUPS OF PEOPLE WHO ARE INTERESTED IN LOOKING AT, FOR EXAMPLE, UNPRESCRIBING MEDICATIONS, BEHAVIORAL -- A VERY STRONG COMPONENT OF NIDDK THAT LOOKS AT DIET. BUT HOW DO YOU COMBINE THIS WITH THE MULTIMODAL INTERVENTION SO THAT YOU'RE NOT JUST LOOKING AT DIET, YOU'RE LOOKING AT AND EXERCISE AND STRESS REDUCTION. BECAUSE YOU HAVE TO DO ALL THREE. ESPECIALLY IF YOU DON'T DEAL WITH THE STRESS, I THINK, THAT'S SOMETHING THAT IS GOING TO BE LACKING, RIGHT, IN THE APPROACH. SO WE DEAL WITH THIS. KIND OF EXPANDING OUR RANGE OF COLLABORATIONS. WE ARE PARTICIPATING IN, FOR EXAMPLE, THE HEAL INITIATIVE, THE BRAIN INITIATIVE, WE'RE COLOCATING WITH MANY OTHER ICs WHERE WE FUND WHAT WE CALL PRAGMATIC TRIALS THAT ARE CLINICAL TRIALS THAT ARE PERFORMED IN THE HEALTHCARE SETTING IN REAL WORLD, WHERE THEY'RE DEVELOPING THESE METHODS TO REALLY STUDY THESE INTERVENTIONS AS THEY ARE PRACTICED. SO YOU'RE RIGHT, THIS IS A CHALLENGE BUT WE'RE DEFINITELY EMBRACING THAT FOR SURE. >> THANK YOU. >> WE ALSO HAVE A QUESTION FROM DR. LANGER. ANA, CAN YOU UNMUTE? IF NOT, I CAN DO IT FOR YOU. THERE YOU GO. >> I THINK I MANAGED TO UNMUTE MY SE. THANK YOU. >> GO RIGHT AHEAD, ANA. >> THANK YOU SO MUCH, DR. LANGEVIN, FOR AN AMAZING PRESENTATION. I COULDN'T SUPPORT YOUR CONCEPTS AND THE PRIORITIES YOU IDENTIFIED MORE, AND I'M VERY EXCITED ABOUT THESE ACTIVITIES. BUT I WONDER, HOWEVER, ABOUT THE RESISTANCE THAT YOU REFERRED TO THAT YOU MIGHT BE EXPERIENCING. THE SOURCES OF THAT POSSIBLE RESISTANCE ARE SO HUGE, SO IMPORTANT, TO SOME EXTENT OUR ENTIRE CULTURE WANT THINGS TO HAPPEN FAST, AND THAT VALUES OBVIOUS EFFECTIVENESS SO MUCH, AND IT'S ALSO SPECIALIZATION -- I CAN'T PRONOUNCE THAT WORD BUT YOU KNOW WHAT I MEAN? >> YES. >> ALSO THE FINANCIAL INTERESTS INVOLVED BEHIND THAT, SO WHAT ARE YOU DOING TO OVERCOME SOME OF THOSE SOURCES OF RESISTANCE? >> YOU NAMED THEM -- THESE ARE ALL THE BLOCKS THAT ARE STACKED AGAINST US. YOU SUMMARIZED IT PERFECTLY. THERE'S SO MANY THINGS THAT YOU MAY SAY, HOW DO WE CHANGE SOMETHING LIKE THIS, WHICH IS SO -- IT GOES SO CONTRARY TO THE GRAIN, RIGHT? I THINK -- FIRST THING YOU MENTIONED, FAST, RIGHT? IT'S SO MUCH EASIER TO JUST TAKE A PILL, GET RID OF YOUR PAIN OR TAKE A PILL, WHERE YOUR BLOOD SHOE TBAR, DON'T SUGAR, YOU KNOW, THERE IS A ROLE FOR DRUGS AND IT MAY BE THAT FOR SOME PEOPLE, THAT'S THE BEST SOLUTION. WE'RE NOT SAYING THAT CHANGING BEHAVIOR IS SOMETHING THAT YOU CANNOT FORCE PEOPLE TO CHANGE THEIR BEHAVIOR BUT YOU CAN HELP THEM, YOU CAN ASSIST THEM. ALSO FOR US, WE'RE HAVE INTERESTED IN TRYING TO FIGURE OUT WHO IS THIS GOING TO HELP THE MOST? WE HAVE LIMITED HEALTHCARE RESOURCES, RIGHT? HOW ARE WE GOING TO IDENTIFY THAT KIND I OF APPROACH AND YOU'RE SAYING MY DREAM AT SOME POINT YOU COULD TAKE SOMEBODY WHO HAS PREDIABETES LIKE THAT PERSON I DESCRIBED IN THE HISTORY. ELEVATED BLOOD SUGAR, ELEVATED BLOOD PRESSURE, OVERWEIGHT AND SAY, LOOK, I'M GOING TO GIVE YOU A YEAR, I'M GOING TO FULLY SUPPORT YOU, WE'RE GOING TO FUND, DIET AND NUTRITION, STRESS MANAGEMENT, WE'RE GOING TO FUND THIS FOR YOU FOR A FULL YEAR AND SEE IF YOU CAN TURN THIS AROUND. AND SEE -- AND FIRST OF ALL FIND OUT, WHO ARE THE PEOPLE WHO GET BETTER AND WHO ARE THE PEOPLE WHO DON'T? SO IT'S IMPORTANT I THINK TO UNDERSTAND THE TOOLS IN OUR TOOLBOX AND HOW WE CAN APPLY THEM THE BEST IN A WAY THAT'S COST-EFFECTIVE. THIS IS ALL NOT GOING TO BE FREE. THE OTHER THING IS, SHOWING THE URGENCY OF THIS. I THINK WE ARE NOW, IF WE LOOK AT THE HEALTH OF THE POPULATION AS A WHOLE, WE'VE HAD DECLINING LIFE EXPECTANCY NOW IN THE UNITED STATES FOR THREE YEARS IN A ROW. WE HAVE AN EPIDEMIC OF NOT ONLY OPIATES, SUICIDE, NOW WE HAVE THE PANDEMIC WHICH WE KNOW IS AIFNGHTING THE AFFECTING THE VERY PEOPLE WHO WERE UNHEALTHY TO START WITH AND THIS OBESITY EPIDEMIC. SO THIS IS NOT HAPPENING IN A VACUUM. PEOPLE ARE STARTING TO PAY ATTENTION TO THIS. I'M TALKING TO CONGRESS AND MAKING SURE THAT THEY UNDERSTAND THAT THIS IS SOMETHING THEY NEED TO PAY ATTENTION -- YOU NEED TO PAY ATTENTION TO. THERE'S AN URGENCY TO THAT IS BECOMING MORE AND MORE APPARENT. SO, YOU KNOW, HOPEFULLY ONCE THE PROBLEM BECOMES URGENT AND SERIOUS ENOUGH, THERE WILL BE MORE RESOURCES AT SOME POINT. >> AMAZING. THANK YOU. SABRA, TO YOU WANT TO UNMUTE AND MAKE YOUR COMMENT ABOUT SEX AND GENDER? >> THERE WE GO. YES. THANK YOU. WONDERFUL PRESENTATION. AGAIN, WE ARE VERY FOCUSED IN THIS MOMENT AND ON THIS BOARD IN THINKING ABOUT SEX AS A BIOLOGICAL VARIABLE, BUT YOU KNOW, I THINK A LOT OF WHAT YOU WERE HIGHLIGHTING EVEN IN TERMS OF WHO YOUR TBRAN TEES ARE, THAT GRANTEES ARE, MAJORITY WOMEN, IT'S HIGHLIGHTING MAJORITY FACTORS AS WELL AND THE MESSAGING MAY HAVE TO BE DIFFERENT IN ORDER TO REACH A BROADER AUDIENCE, THAT YOU CLEARLY ARE REACHING WOMEN IN MUCH OF WHAT YOU PRESENTED. I CAN SEE IN OTHER WOMEN'S GROUPS THAT I'M IN, BUT AT JOHNS HOPKINS, I'M NOT SEEING THIS IN MAINSTREAM MEDICINE, WHICH IS DOMINATED BY MEN. SO I DO THINK IT'S THIS INTERESTING -- YOU KNOW, THERE'S SOME BIOLOGY ASSOCIATED WITH ALL THIS, BUT THEN THERE ARE SOME GENDER ASSOCIATED FACTORS THAT PLAY AS WELL. SO IT WAS MORE JUST A COMMENT AND MAYBE TO HAVE YOU SPEAK TO THAT COMMENT AS OPPOSED TO A QUESTION. THANK YOU. >> YOU'RE RIGHT, AND WE'RE STILL -- IT'S STILL A MALE DOMINATED CULTURE, RIGHT, AROUND MEDICAL SCHOOLS, UNLESS WE HAVE THE WOMEN AT THE TOP IN DEAN POSITIONS, THAT'S GOING TO TAKE TIME AND WE'RE ALL KIND OF WORKING TOWARDS THAT. I THINK THAT TO HAVE GOOD REPRESENTATION AT ALL LEVELS OF DECISION-MAKING IS VERY IMPORTANT WHEN YOU TALK ABOUT WHAT THE IMPORTANCE IS GOING TO BE IN PROGRAMS. I MENTIONED EARLIER KRUK LUM, YOU CURRICULUM, HOW DO YOU DECIDE WHAT'S GOING TO BE IN THE CURRICULUM, HOW DO YOU DECIDE WHO'S GOING TO BE ABLE TO START A NEW PROGRAM, FOR EXAMPLE? SO YEAH, THIS IS A LONG ROAD AHEAD, BUT I THINK THE FACT THAT WE ARE ATTRACTING A LOT OF TALENTED FEMALE SCIENTISTS -- >> I AGREE. >> -- TO THE FIELD IS NICE. I MEAN, IT SORT OF TELLS YOU THAT THERE'S A BIT OF A PULL TOWARDS THIS KIND OF RESEARCH THAT WE ARE DELIGHTED TO SEE, SO WE WANT TO DEFINITELY ENCOURAGE IT. WE DON'T WANT TO LEAVE THE MEN BEHIND, SK O WE NEED THEM TOO, BUT WE WANT THIS, AS YOU MENTIONED, TO GET INTEGRATED INTO MAINSTREAM MEDICINE. >> YEAH. AND THE ONLY OTHER THING I'D LIKE TO HIGHLIGHT, I KNOW YOU TALKED ABOUT CONGRESS AND OTHER, YOU KNOW, JUST SPEAKING OUT TO GARNER MORE SUPPORT, I THINK THE OTHER PLACE WHERE I MIGHT SUGGEST, THERE THERE COULD BE SOME REAL NEED FOR MAYBE SOME LOBBYING IS WITH JOURNAL EDITORS, BECAUSE I THINK THE OTHER THING THAT HAPPENS TOO OFTEN IS THAT THESE TYPES OF AREAS OF STUDY, NO MATTER HOW RIGOROUS THEY MAY BE, ARE PROBABLY NOT GOING TO -- WE'RE NOT GOING TO SEE THEM LIKELY PUBLISHED IN THE MOST IMPACTFUL MEDICAL JOURNALS, BUT WITH THAT, THAT'S HOW YOU GET ACCEPTANCE. THE MINUTE IT'S SHOWING UP THERE, YOU GET BROADER ACCEPTANCE OF CONCEPTS, WHETHER THAT'S SABV OR COMPLEMENTARY MEDICINE. SO THERE MIGHT BE SOME LOBBYING THAT SHOULD BE DONE WITH JOURNAL EDITORS AND WHO -- YES, THE TYPE OF WORK THAT THEY TEACH. >> WE'RE ACTUALLY IN THE MIDDLE OF PUTTING TOGETHER A STAKEHOLDER GROUP ON WHOLE PERSON HEALTH, AND THAT'S ONE OF THESE THINGS THAT WE'RE GOING TO TALK ABOUT. >> SO DR. MCGREGOR, WE DO HAVE A FEW MINUTES SO UNMUTE SO YOU CAN ASK YOUR QUESTION. >> GREAT, THANK YOU. SO MANY AMAZING POINTS HAVE BEEN BROUGHT UP, AND AS A PRACTICING EMERGENCY MEDICINE PHYSICIAN, I WILL TELL YOU THAT I CAN SEE TWO MAJOR CHALLENGES IN THE FUTURE OF MAKING THIS SOMETHING THAT'S ENGRAINED. ONE IS THAT PART OF THE CONCEPT THAT YOU'RE SPEAKING OF IS DE-ESCALATING MEDICINE, SO TRYING TO GET PATIENT OFF OF A LOT OF THESE MEDICINES, LOTS OF PHYSICIANS ARE INCENTIVIZED TO PUT PATIENTS ON MEDICINE, TO ORDER TESTS, TO SORT OF BE PART OF THAT TRADITIONAL MODERN WAY. AND THEN THERE'S THE EXPECTATION FROM THE PATIENTS. MOST OF THE PATIENTS I SEE DON'T WANT TO WAIT FOR PRIMARY CARE VISITS. THEY'LL COME IN WITH THEIR CHRONIC PROBLEMS AND I'LL SAY DID YOU CALL YOUR PRIMARY CARE DOCTOR TO DISCUSS THIS? AND THEY'LL SAY, NO, OR THEY COULDN'T SEE ME UNTIL TOMORROW. SO THEY'RE VERY MUCH INTO WANTING THINGS VERY EFFICIENTLY, WANTING TEST RESULTS, AND YOU THINK -- SO THOSE ARE SOME MAJOR CHALLENGES FOR THIS, BUT I COMPLETELY SUPPORT THIS. >> IT A SOCIETAL PROBLEM, RIGHT? WE WANT EVERYTHING YESTERDAY. AND YOU KNOW, WE'RE A VERY FAST SOCIETY. WE WANT THINGS, WE WANT INSTANT RESULTS, AND SOME OF THAT IS UNFORTUNATELY THERE. I THINK YOU CAN TURN THE TIE TITANIC. THIS IS NOT GOING TO BE QUICK. WE HAVE TO JUST BE REALISTIC AS TO HOW MUCH WE CAN CHANGE PEOPLE'S BEHAVIOR BECAUSE THAT'S A BEHAVIOR, RIGHT, THAT WE'RE TALKING ABOUT, AND IT'S THE WHOLE THING ABOUT HOW DO YOU CHANGE BEHAVIOR. YOU NEED AN INCENTIVE. YOU NEED HELP. SO, YOU KNOW, YEAH, WE'RE GOING TO KEEP CHIPPING AWAY AT IT. >> YOU JUST NEED TO CHANGE THE INCENTIVE. >> CHANGE THE INCENTIVE. AND KNOWING THE URGENCY, I THINK WHEN PEOPLE START TO REALIZE THAT -- AND I THINK -- I'M OPTIMISTIC THERE'S GOING TO BE A SILVER LINING TO THIS COVID-19 CATASTROPHE, IS THAT IT'S GOING TO MAKE PEOPLE REALIZE THAT THE TERRAIN ON WHICH THE VIRUS LANDS MAKES A DIFFERENCE. I KNOW A LOT OF -- I'VE BEEN HEARING A LOT OF PEOPLE SAYING, JEEZ, I'M GOING TO START LOSING WEIGHT, I'M GOING TO START EXERCISING. I REALIZE NOW THAT THAT'S -- THIS IS IMPORTANT. PEOPLE FEEL VULNERABLE. >> THANK YOU. >> WE HAVE ONE MINUTE LEFT, SO I'D LIKE DR. RIOS TO GO AHEAD AND UNMUTE IF YOU WANT TO MAKE YOUR COMMENT. DR. RIOS, ELENA? THERE WE GO. >> YES. SORRY. I REALLY LIKE THIS PRESENTATION. IT'S SO IMPORTANT, ESPECIALLY FOR THE HEALTH DISPARITIES IN ALL OF OUR COMMUNITIES TO LOOK AT THE WHOLE PERSON AND ALL OF THE SOCIAL DETERMINANTS THAT IMPACT US, ESPECIALLY TOXIC STRESS. BUT ONE THING I FOUND MISSING, AND THIS IS JUST REALLY THE WAY I LOOK AT THE WORLD HERE, IS THAT WE'RE SO MUCH INTERESTED IN HOW TO GET OUR COMMUNITIES TO TRUST OUR PROGRAMS, OUR GOVERNMENT, OUR RESEARCH, ESPECIALLY AFRICAN AMERICAN AND LATINOS, BUT FOR THE LATINA WOMEN, WE REALLY LOOK AT FAMILY, AND MORE IMPORTANTLY, FOR THOSE ELDERLY WOMEN WHO ARE ISOLATED -- MY MOTHER WAS A NURSE AND TRAVELED TO -- SHE WAS A HOME CARE NURSE FOR A LARGE COMMUNITY HEALTH CENTER. AND ALWAYS TOLD ME ABOUT THE STORIES SHE SAW. AND IT'S THOSE WHO HAVE CONNECTION TO SOCIAL SUPPORT THAT LAST. ANYWAY, I DIDN'T SEE THAT AND MAYBE I JUST MISSED IT, I KNOW IT'S A PSYCHOLOGICAL PROBLEM. >> NO, YOU'RE RIGHT, YOU KNOW THAT SLIDE WHERE I HAD THE TWO ARROWS? I SHOULD PUT "FAMILY" IN THERE. YOU'RE RIGHT. THANK YOU. I WILL ADD IT, BECAUSE IT'S SUCH AN IMPORTANT PART OF THIS. AND I'M GLAD YOU MENTIONED THE LATINAS BECAUSE WE CAN LEARN SO MUCH FROM LOOKING AT THOSE COMMUNITIES WHERE THERE IS SUPPORT, HOW DOES THAT WORK, HOW DOES THAT HELP, HOW DO WE LEARN FROM THAT, ALL OF US, RIGHT? >> IT REALLY IS AN ASSET MODEL THAT WE HAVE TO DO MORE RESEARCH ABOUT FOR WOMEN THEMSELVES. >> THAT'S A VERY GOOD COMMENT. THANK YOU. >> THANK YOU, HELENE, FOR AN AMAZING PRESENTATION AND COLLEAGUES ON ACRWH FOR GREAT QUESTIONS AND COMMENTS AND DISCUSSION. YOU'VE GIVEN US A LOT TO THINK ABOUT. I'M SO EXCITED FOR YOUR LEADERSHIP OF NCCIH AND I SEE THAT YOU'RE A COURAGEOUS WOMAN, YOU'RE NOT AFRAID TO TAKE ON SOMETHING THAT IS GOING TO BE -- >> YOU INSPIRED ME. >> WELL, WE ARE WORKING TOGETHER, AND ORWH IS HERE TO WORK WITH YOU ON INTEGRATING SEX AND GENDER THROUGH YOUR WHOLE PERSON HEALTH, AND I REALLY PARTICULARLY APPRECIATED THE WAY THAT YOU BROUGHT OUR ATTENTION TO HOW PEOPLE ARE USING THAT WORD PERSONALIZED. IN DIFFERENT WAYS. I'VE TENDED TO START USING ALMOST THE OLD WORD, WHICH IS INDIVIDUALIZED, WHERE THAT'S PRETTY CLEAR, IT'S LESS CONFUSING. THANK YOU, HELENE, SO MUCH FOR JOINING AND PRESENTING YOUR PERSPECTIVE. WE LOOK FORWARD TO HAVING YOU BACK IN A YEAR OR TWO TO GIVE US AN UPDATE. >> ABSOLUTELY. THANK YOU VERY MUCH, IT'S A PLEASURE. >> THANK YOU SO MUCH. >> BYE-BYE. >> AND NOW I'D LIKE TO ASK DR. REBECCA WIGGINS, HEALTH SCIENCE ADMINISTRATOR AND RESEARCH PROGRAM ADMINISTRATOR AT ORWH TO INTRODUCE OUR NEXT SPEAKER. >> THANKS, DR. CLAYTON. CAN YOU HEAR ME? HELLO, EVERYONE. IT IS MY PLEASURE TO INTRODUCE OUR NEXT SPEAKER, DR. SABRA KLEIN, WHO IS BOTH AN ADVISORY COMMITTEE MEMBER AND AN EXPERT ON SEX AND GENDER DIFFERENCES IN THE IMMUNE RESPONSES AND SUSCEPTIBILITY TO INFECTION. DR. KLEIN IS A PROFESSOR OF MOLECULAR MICROBIOLOGY AND IMMUNOLOGY AT THE JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH. DURING THE INFLUENZA PANDEMIC OF 2009, SHE WAS COMMISSIONED BY THE WORLD HEALTH ORGANIZATION TO EVALUATE AND PUBLISH A REPORT ON THE IMPACT OF SEX AND GENDER IN PREGNANCY AN THE OUTCOME OF VIRAL INFLUENZA INFECTION. DURING THE CURRENT COVID-19 PANDEMIC, DR. KLEIN HAS WRITTEN NUMEROUS COMMENTARIES FOR PROMINENT JOURNALS AND HAS BEEN INTERVIEWED BY SEVERAL MAJOR NEWS MEDIA OUTLETS ABOUT MALE BUY BIASED DISEASE OUTCOMES. SHE IS THE PRINCIPAL INVESTIGATOR OF A JOHNS HOPKINS SCORE PROGRAM, WHICH STANDS FOR SPECIALIZED CENTER FOR RESEARCH EXCELLENCE, IN SEX AND GENDER -- IN SEX AND AGE DIFFERENCES AND IMMUNITY TO INFLUENZA. SHE ALSO IS THE CO-PI OF THE JOHNS HOPKINS SEROLOGICAL COVID-19 CENTER OF EXCELLENCE, THE CO-CHAIR OF THE ADVISORY BOARD OF THE JOHNS HOPKINS BIRCWH PROGRAM AND JOHNS HOPKINS CENTER FOR WOMEN'S HEALTH, SEX AND GENDER RESEARCH. WELCOME, DR. KLEIN. >> THANK YOU SOL MUCH. I COULDN'T HAVE ASKED FOR A BETTER PERSON TO DO MY INTRO. IT'S ALWAYS FUN TO SEE YOU. I THINK YOU HAVE MY SLIDES. THEY'RE SOMEWHERE OUT THERE. THERE THEY ARE. SO I AM HONORED TO BE SPEAKING WITH ALL OF YOU TODAY. I THINK WE HAD A PREVIOUS LEAD-IN WITH OUR PREVIOUS TWO DISCUSSIONS TO MAYBE BEGIN TO DELVE A TOUCH MORE DEEPLY INTO SEX DIFFERENCES AND COVID-19 IMMUNITY. I DO NOT NEED TO DESCRIBE THIS IN ANY GREAT DETAIL TO THIS GROUP, JUST TO SAY THAT SEX IS A BIOLOGICAL VARIABLE THAT AFFECT OUR IMMUNE SYSTEM AND IMMUNE RESPONSES. THE POINT I WANT TO MAKE WITH EACH OF YOU IS LESS ABOUT WHAT CONSTITUTES SEX AS A BIOLOGICAL VARIABLE AND MORE JUST THAT WE DO KNOW IN MY GROUP AS WELL AS MANY OTHER GROUPS ARE PROVIDING EMPIRICAL EVIDENCE THAT HORMONE DEPENDENCE SIGNALING THAT HAD TYPICALLY BEEN LIMITED TO DISCUSSIONS PERTAINING TO REPRODUCTIVE PHYSIOLOGY AND BEHAVIOR, WE KNOW THIS SIGNALING AFFECT THE FUNCTIONING OF IMMUNE CELLS TO ALTER INNATE AND ADAPTIVE IMMUNITY, DEVELOPMENT OF INFLAMMATION, AND EVEN DEVELOPMENT OF AUTOIMMUNE DISEASES WHERE OUR IMMUNE SYSTEM APPROPRIATELY BEGINS ATTACKING OUR CELLS. IN ADDITION TO HORMONE DEPENDENT SIGNALING, WE KNOW THAT EXCELLENT GENES CAN PLAY A ROLE FOR REASONS THAT ARE STILL UNCLEAR, THE X CHROMOSOME IS ENRICHED FOR IMMUNE RESPONSE-RELATED GENES AND I WILL MAKE MENTION OF THAT TODAY. BUT EVEN AS DR. CLAYTON POINTED OUT, THERE ARE A NUMBER OF DIFFERENCES BETWEEN MALES AND FEMALES IN GENES THAT ARE ENCODED WITHIN THE AUTOSOME SO THAT SHARED GENETIC MATERIAL, THERE ARE A NUMBER OF DIFFERENCES. ALL OF THIS COMBINED CONTRIBUTES OW MALE AND PEE NAIL IMMUNE RESPONSES CAN DIFFER WHEN WE SEE SOMETHING FOREIGN SUCH AS A VIRUS LIKE COV2. WITHOUT GOING INTO TOO MUCH DETAIL, THIS IS FROM AN OLDER REVIEW THAT I WROTE WITH A DEAR FRIEND AND COLLEAGUE, KATIE FLANAGAN. I DO WANT TO MAKE THE POINT WITH YOU THAT WE DO KNOW THAT THERE ARE SEX DIFFERENCES IN IMMUNE FUNCTION THAT OCCUR OVER OUR LIFE COURSE. I THINK A REALLY OPEN AREA WHERE WE REALLY UNDERSTAND THE LEAST IS IN TERMS OF THE DEVELOPMENT OF THE IMMUNE SYSTEM, BOTH IN UTERO AND PRIOR TO PUBERTY, WE UNDERSTAND VERY LITTLE ABOUT THE DEVELOPMENT AND SOME OF THOSE DIFFERENCES THAT MAY OCCUR DEVELOPMENTALLY BETWEEN MALES AND FEMALES THAT COULD UNDERLIE VERY WELL CHARACTERIZED AND KNOWN DIFFERENCES IN SUSCEPTIBILITY TO DISEASE EARLY IN LIFE. WE PROBABLY KNOW THE MOST ABOUT WHAT GOES ON DURING WHAT I MIGHT REFER TO AS OUR REPRODUCTIVE YEARS. SO AFTER PUBERTY, THROUGH KIND OF OUR REPRODUCTIVE YEARS OF ADULTHOOD, SO PRIOR TO WHEN WOMEN ENTER THE MENOPAUSAL OR THE PERIMENOPAUSAL PERIOD. AS A GENERAL ROLE OF THUMB DURING THOSE REPRODUCTIVE YEARS IF YOU WILL, FEMALES TEND TO MOUNT GREATER OR MORE ROBUST IMMUNE RESPONSES TO LOTS OF DIFFERENT STIMULI THAN DO MEN. AND WE'LL DISCUSS THIS. IN OLDER AGE, WE OFTEN SEE A REDUCTION IN SOME OF THOSE SEX DIFFERENCES, IN OTHER CASES A REVERSAL IN THOSE SEX DIFFERENCES, AND GENERALLY SPEAKING, WHEN WE SEE AGE-ASSOCIATED CHANGES IN THE DEGREE TO WHICH THE SEXES DIFFER IN THEIR IMMUNE RESPONSE, WE OFTEN ATTRIBUTE THIS TO HORMONES, AND WE TEND TO SEE A DIFFERENCE THAT REMAIN THE SAME AND REMAIN VERY PRONOUNCED ACROSS DIVERSE AGE RANGES, WE OFTEN START TO LOOK TO OTHER POSSIBLE GENETIC BUT MAYBE EVEN ENVIRONMENTAL FACTORS THAT COULD PLAY A ROLE. THIS IS NOT TO SAY THAT SEX DOES NOT INTERSECT WITH GENDER, AND I THINK AS WE ARE EVALUATING AND TRYING TO BETTER UNDERSTAND AND ARTICULATE HYPOTHESES FOR MALE/FEMALE DIFFERENCES IN THE CURRENT COVID-19 PANDEMIC, WE CANNOT IGNORE THE INTERSECTION THAT OCCURS BETWEEN BIOLOGICAL SEX, SO AGAIN, THE SEX CHROMOSOME, THE SEX HORMONAL DIFFERENCES THAT CAN IMPACT ON THE PATHOPHYSIOLOGY OF DISEASE, OUR IMMUNE RESPONSES TO A VIRUS, MAYBE A VACCINE, BUT THAT THIS IS NOT OCCURRING IN A VACUUM. WHILE ANIMAL STUDIES MAY CREATE A BIT OF A VACUUM AS WE'RE CURRENTLY EVALUATING A LOT OF THE HUMAN DATA, WE CANNOT IGNORE THESE GENDER CONSTRUCTS, SO AS OUR PREVIOUS SPEAKER SUGGESTED, THERE ARE DEFINITELY IN THE CONTEXT OF HOW WE CONSIDER MORE OF THIS COMPLEMENTARY OR INTEGRATIVE MEDICINE, THAT LIFESTYLE, NUTRITION, EXERCISE, PERCEIVED STRESS, EVEN SMOKING, CAN ALL SERVE AS GENDER CONSTRUCTS THAT CAN INFLUENCE, IN THE CASE OF COVID-19, OUR EXPOSURE TO A VIRUS OR POSSIBLY OUR BIOLOGIC SUSCEPTIBILITY. SO I DON'T WANT TO IGNORE THIS AND I THINK COVID-19 IS REALLY PRESENTING US WITH A UNIQUE OPPORTUNITY TO THINK MORE DEEPLY ABOUT THE INTERSECTION BETWEEN SEX AND GENDER. SO AS HAS BEEN STATED BY DR. CLAYTON IN HER OPENING REMARKS FOR US TODAY, FEMALES ARE MORE LIKELY THAN MAILS TO SURVIVE SARS COV2 INFECTION. IN A PANDEMIC THAT IS MOVING QUICKLY AND DATA COMING AT US IN REALTIME, THESE ARE SOME GRAPHICS, SOME OF WHICH WERE USED IN A COMMENTARY THAT I WROTE WITH TWO COLLEAGUES AND WE PUBLISHED IN THE JOURNAL OF CLINICAL INVESTIGATIONS. IT'S NOW DATED. IT'S AMAZINGS HOW TWO TO THREE MONTHS IN THIS MOMENT FEELS LIKE A LIFETIME, BUT THE POINTS ARE ABSOLUTELY STILL ACCURATE IN OUR MORE RECENT ANALYSES. SO WHEN WE LOOK AT WHO IS SEX-DISAGGREGATING DATA, WHICH I DO THINK IS IMPORTANT, NOT ALL COUNTRIES ARE EQUAL IN THIS REGARD, AND THERE ARE NO REQUIREMENTS TO DISAGGREGATE DATA. SO THERE ARE DEFINITELY COUNTRIES WHERE THERE'S NO SEX DISAGGREGATION. ONE THING THAT WOULD CHANGE IS WE DO HAVE MORE DATA FROM AFRICA BUT BY AND LARGE, MOST COUNTRIES IN AFRICA, IN THAT CONTINENT, ARE NOT SEX-DISAGGREGATING DATA. WE HAVE COUNTRIES THAT ARE SEX-DISAGGREGATING ALL DATA COMING OUT OF THOSE COUNTRIES, WHETHER IT'S ABOUT CASES, HOSPITALIZATIONS, DEATHS, AND THAT'S IN BROWN. IN THE GOLD CORE ARE COUNTRIES THAT PROVIDING PARTIAL SEX-DISAGGREGATED DATA, INCLUDING THE UNITED STATES. AND THE CONFUSION ESPECIALLY WITHIN THE UNITED STATES, THE INDIVIDUAL STATES ALL DIFFER. WE DID WANT TO POINT OUT IN THIS PARTICULAR REVIEW PAYING MIND TO HEALTHCARE WORKERS, BECAUSE OUR FRONT LINE WORKERS HAVE INCREASED RATES OF EXPOSURE AND WORLDWIDE, 70% OF ALL HEALTHCARE WORKERS ARE FRONT LINE HEALTHCARE WORKERS, ARE WOMEN. SO WHERE YOU SEE THE STIPPLED LINES, THAT MEANS THAT THERE ARE ALSO SOME SEX-DISAGGREGATED DATA PERTAINING TO HEALTHCARE WORKERS. IF WE LOOK AT THESE PIE CHARTS, IN PINK ARE STEREO TYPICALLY COUNTRIES THAT ARE REPORTING A FEMALE BIAS, BLUE, STEREO TYPICALLY COUNTRIES REPORTING A MALE BIAS, AND GREY ARE COUNTRIES FOR WHICH A BIAS IS NOT BEING OBSERVED. IF WE FIRST LOOK AT COVID-19 CASES, WE'RE REALLY FINDING A VERY MIXED PATTERN, WHICH TO ME THEN SUGGESTS A ROLE FOR GENDER IN EXPOSURE, PROBABLY REPORTING, MAYBE EVEN IN SOME COUNTRIES ACCESS TO TESTING. SO WE REALLY DO SEE A REAL MIXED PATTERN AROUND THE WORLD. BUT I WANT TO BRING YOUR ATTENTION TO WHAT MYSELF AND OTHERS HAVE REPEATEDLY MADE NOTE OF IN OUR WRITINGS, THAT THE DEATH RATES ARE JUST -- IT AN UNBELIEVABLE MALE BIAS THAT'S BEING REPORTED IN COUNTRIES DISAGGREGATING THEIR DATA. ONLY 2% ARE REPORTING A FEMALE BIAS AND 11% ARE REPORTING NO BIAS. SO I LOVE WHEN GROUPS OF MEDICAL DOCTORS COME TOGETHER, MAKE AN OBSERVATION AND THEY'RE NOT NECESSARILY A GROUP THAT STUDIES SEX AS A BIOLOGICAL VARIABLE BUT THEY HAPPEN UPON IT. THIS IS RARE AND IT'S RARE FOR FIGURE 1 OF A SCIENCE PAPER TO HIGHLIGHT THAT A SEX DIFFERENCE WAS ONE OF THE BIGGEST OBSERVATIONS MADE. SO THESE ARE DATA FROM FRANCE, AND THEY WERE REPORTING DATA FROM MARCH THROUGH MAY, WHICH IS INDICATED IN PANEL A. PANEL B ARE THOSE RENALES OF THE COUNTRY MOST HARDEST HIT, BUT WHAT I REALLY WANT TO POINT YOUR ATTENTION TO IS PANELS C, D AND E LOOKING AT HOSPITALIZATIONS, ICU ADMISSIONS AND DEATH. AND WHAT YOU CAN SEE, MALED ARE THE LIGHT BLUE, FEMALES ARE THE REDDISH ORANGE COLOR, AND WHAT I LIKE ABOUT THIS PARTICULAR GRAPHIC IS WE'RE STARTING TO LOOK AT THE INTERSECTION WITH AGE. WHICH IS ON OUR X AXIS OF EACH OF THESE PANELS. WHAT YOU CAN SEE IS THAT ACROSS DIVERSE AGE GROUPS, MALES ARE SIGNIFICANT ALREADY MORE LIKELY TO BE HOSPITALIZED, TO BE ADMITTED INTO AN INTENSIVE CARE UNIT AT A HOSPITAL, SO THAT WOULD BE AN INDICATION OF GREATER SEVERITY OF DISEASE, AND ARE SIGNIFICANTLY MORE LIKELY TO DIE. THAT IS ACROSS VERY DIVERSE AGE RANGES. WHILE FOR BOTH MEN AND WOMEN, WE DO SEE AN INCREASE IN SEVERITY WITH DISEASE WITH AGE, SO THAT AGE-ASSOCIATED EFFECT, IT'S TRUE FOR WOMEN, MUCH THE WAY IT IS FOR MEN. BUT WE STILL SO THAT MEANT WE HAVE MORE MEN EXPERIENCING SEVERE OUTCOMES, INCLUDING DEATH. SO WE KIND OF LOOKED AT THIS IN A RECENT REVIEW I PUBLISHED WITH A DEAR FRIEND AND JUNIOR FACULTY AT JOHNS HOPKINS, EILEEN SCULLY, LOOKING AT MALE-BIASED FATALITY RATES ACROSS COUNTRIES AND AGES. SO A, COUNTRIES THAT WERE SEX-AGGREGATING, AND 37 OF THE 38 COUNTRIES THAT ARE LISTED HERE REPORTED A SEX BIAS. WITH SIGNIFICANTLY MORE MEN DYING. AND THIS IS TRUE IN ENGLAND, WHERE FATALITY RATES WERE VERY GREAT. THIS WAS ALSO TRUE IN COUNTRIES SUCH AS SOUTH AFRICA, WHERE WHILE THERE MAY NOT BE AS GREAT OF A CASE FATALITY RATE, THE MALE BIAS IS STILL PRONOUNCED. SIMILAR TO WHAT I JUST SHOWED YOU FROM FRANCE, WHEN WE LOOKED AT THE CASE FATALITY RATES IN BOTH COUNTRIES DIG -- YOU DO SEE AN INCREASE IN CASE FATALITY WITH AGE FOR BOTH MEN AND WOMEN BUT YOU STILL HAVE SIGNIFICANTLY MORE MEN DYING. I WANT TO POINT OUT THAT SOMETHING THAT EILEEN AND I ARE WORKING ON NOW AND JOHNS HOPKINS IS TRYING TO BETTER UNDERSTAND SOME OF THE DIVERSITY IN WHO CONSTITUTES THESE YOUNGER AGE GROUPS AS WELL AS THESE OLDER AGE GROUPS. AND I JUST WANT TO POINT OUT, BECAUSE I DO THINK THE OFFICE OF RESEARCH ON WOMEN'S HEALTH IS VERY INTERESTED IN RACIAL AND ETHNIC DISPARITIES, AND WHAT WE ARE FINDING IN PATIENTS HOSPITALIZED AND IN SOME CASES DIE OF COVID-19, AT THESE YOUNGER AGE GROUPS, SO AT THESE INDIVIDUALS WHO ARE ROUGHLY, YOU KNOW, 40 TO 50, MAYBE INTO THEIR 50s AND 60s, IS PRIMARILY LATINX MEN. 60s TO 75 ARE PRIMARILY AFRICAN AMERICAN MEN, AND WE'RE REALLY SEEING CAUCASIAN MEN COME UP IN THOSE INDIVIDUALS 75 YEARS OLD AND OLDER. SO HOW WE SEE RACE ETHNICITY INTERSECT WITH SEX AND WHAT ROLE COMORBIDITIES PLAY, I DO THINK THIS IS REALLY IMPORTANT AND THIS IS SOMETHING THAT WE ARE ATTEMPTING TO EXPLORE IN THESE EARLY STAGES. AGAIN I'M A BIOLOGIST SO I WANT TO SHARE WITH YOU SOME HYPOTHESIZED WAYS BY WHICH SEX COULD IMPACT COVID-19. SO THE VIRUS, IN ORDER TO ENTER INTO OUR CELLS, HAS TO USE A RECEPTOR CALLED ACE 2. AND EPITHELIAL CELLS AND IN PARTICULAR RESPIRATORY EPITHELIAL CELLS ARE VERY RICH IN EXPRESSING THIS ACE 2 RECEPTOR. THIS IS AN X-LINKED RECEPTOR, AND DATA FROM PREVIOUS BOARD MEMBERS INCLUDING KATHRYN SANDBERG HAVE DONE A LOT OF WORK SHOWING AT LEAST IN THE KIDNEY THAT THIS RECEPTOR DOWNREGULATED BY ESTROGENS, AND THAT YOU DO FIND GREATER EXPRESS OF ACE 2 IN CELLS FROM MALES THAN FROM FEMALES. TMPRS2 IS A RECEPTOR THAT THE VIRUS KIND OF LATCH ON AND ATTACH ITSELF TO THE CELL, >> Dr. AND ANDROGENS HAVE BEEN SHOWN TO REGULATE THIS. THERE ARE SEVERAL TRIALS GOING ON AT MANY PLACES INCLUDING JOHNS HOPKINS. IN ITALY, THERE WAS AN INTERESTING OBSERVATION, THIS IS AN OBSERVATION, THAT MEN BEING TREATED FOR PROSTATE CANCER WITH AN ANDROGEN DEPRIVATION THERAPY, WHEN THEY COMPARED MEN WITH PROSTATE CANCER WHO WERE ON THIS TYPE OF ANDROGEN DEPRIVATION THERAPY TO MEN WHO WERE NOT ON THIS ANDROGEN DEPRIVATION THERAPY AND LOOKED AT CASES OF COVID-19 IN ITALY, SO THIS WAS AT THE HEIGHT OF THEIR FIRST WAVE IN ITALY, THERE WERE SIGNIFICANTLY FEWER CASES OF SARS COV2 INFECTION IN MEN ON ANDROGEN DEPRIVATION THERAPY AS COMPARED WITH THOSE WHO WERE NOT. SO SUGGESTING THERE COULD BE A ROLE FOR TESTOSTERONE IN THE ABILITY OF CELLS TO BECOME PRODUCTIVELY EFFECTIVE. AND AGAIN, THERE ARE A NUMBER OF TRIALS ONGOING. ONCE THE VIRUS HAS ENTERED OUR CELLS, WE NEED TO UTILIZE DIFFERENT RECEPTORS THAT WE HAVE INCLUDING PATTERN RECOGNITION RECEPTORS SUCH AS TLR7, WHICH IS AN X-LINKED GENE. SEVERAL GROUPS INCLUDING MY OWN RESEARCH GROUP HAVE SHOWN THAT THERE CAN BE GREATER EXPRESSION OF TLR7 IN CELLS FROM FEMALES AS COMPARED WITH MALES. THERE WAS A REALLY INTERESTING STUDY, IT'S A SMALL COHORT STUDY THAT WAS PUBLISHED ABOUT A MONTH AGO NOW IN JAMA SHOWING THAT MEN THAT HAVE MUTATION IN TLR7 ARE SIGNIFICANTLY MORE LIKELY TO EXPERIENCE MORE SEVERE DISEASE AND BEING X-LINKED, YOU'RE GOING TO GET THESE MUTATIONS BEING EXPRESSED IN MEN BUT NOT WOMEN. UNFORTUNATELY IN THE TITLE OF THE PAPER AS WELL AS IN ALL THE TWEETS THAT I WAS SEEING, THE TITLES KEPT READING TLR TLR7 MUTATION IN PEOPLE. IT WAS REALLY GETTING MISSED THAT THIS WAS ONLY SEEN IN MEN AND IT EXPLAINED AT LEAST IN TWO SEPARATE FAMILIES INCREASED SEVERITY OF DISEASE AT YOUNGER AGES. SO THESE WERE MEN IN THEIR 20s AND 30s WHO IN ONE CASE DIED FROM COVID-19. SO I DO THINK THERE IS A LOT TO BE EXPLORED THERE. INNATE IMMUNE RESPONSES, DR. CLAYTON BROUGHT UP SOME OF THE CYTOKINE DATA AND I'LL HIGHLIGHT OTHERS AS WELL, AS WELL AS ADAPTIVE IMMUNE RESPONSES. DR. CLAYTON HIGHLIGHTED SOME OF THE WORK WITH T-CELLS. I'M GOING TO KIND OF REITERATE THAT AND TALK ALSO ABOUT THESE CELLS. ULTIMATELY I THINK THIS CONTRIBUTES TO WHETHER WE'RE GOING TO SEE PROTECTION OR PATHOLOGY. AND I'LL GO INTO MORE DETAIL ABOUT THAT AS WELL. SO THERE ARE DEFINITELY DATA THAT ARE -- A LOT OF GROUPS THAT ARE VERY INTERESTED IN CYTOKINES. THIS CONCEPT OF THE CYTOKINE STORM MADE POPULAR BY INFLUENZA VIRUSES. WE ARE SEEING SOME EVIDENCE OF THE CYTOKINE STORM. I THINK THE VERDICT IS STILL -- WE DON'T HAVE A COMPLETE PICTURE OF THIS, BUT I THOUGHT THIS WAS A BEAUTIFUL PAPER, OBVIOUSLY JUST PUBLISHED RECENTLY, SHOWING THAT FOR SEVERAL PRO INTRI INFLAMMATORY CYTOKINES, TALKING ABOUT INFLAMMATION OCCURRING PRIMARILY AT THE SITE OF INFECTION, SO IN THIS CASE, IN OUR RESPIRATORY TRACT. ONE OF THE CYTOKINES THAT KEEPS COMING UP IS IL-6, ANOTHER IL8, TNF ALPHA, AND LESS SO IL-1 BETA, AT LEAST IN NON-PREGNANT -- WE HAVE OTHER STUDIES GOING ON IN PREGNANT WOMEN SHOWING IL-1 BETA IS POSSIBLY VERY IMPORTANT. BUT WHEN WE LOOK AT THOSE INDIVIDUALS WHO ARE POSITIVE FOR SARS COV2 INFECTION, SO THAT'S THAT PANEL A, WE FIND THAT PEOPLE WHO ARE INFECTED DO HAVE HIGHER CONCENTRATIONS OF THESE CYTOKINES IN THEIR SERUM. IF YOU LOOK IN PANEL B, DATA GET BROKEN DOWN BY SEX, AGE, EVEN BODY MASS INDEX, AS WELL AS RACIAL AND ETHNIC GRAWPS. GROUPS. YOU WHAT THEY DID FIND WAS THAT AT LEAST FOR IL-6, MALES HAD GREATER CONCENTRATIONS OF IL-6 THAN FEMALES AS DID OLDER INDIVIDUALS. IF YOU GO DOWN TO THE BOTTOM, WHAT THEY'RE LOOKING AT IS SURVIVAL PROBABILITY DEPENDING ON WHETHER AN INDIVIDUAL HAD HIGH CONCENTRATIONS OR LOW CONCENTRATIONS. AND IL-6 IN PARTICULAR PROVES TO BE ONE OF THE BEST INDICATORS OF YOUR SURVIVAL PROBABILITY. AND THOSE INDIVIDUALS, YOU HAD THE HIGHEST CONCENTRATIONS OF IL-6 WHICH DID INCLUDE MEN AND OLDER INDIVIDUALS HAD THE GREATEST -- OR HAD THE LOWEST PROBABILITY OF SURVIVAL. SO THESE ARE DATA THAT DR. CLAYTON ALREADY SHOWED FROM DR. IWASAKI'S LABORATORY AT YALE, AND I WOULD REALLY LIKE TO TAKE THIS MOMENT TO CALL OUT THE WORK OF ONE OF OUR FELLOW BOARD MEMBERS, DR. MASUR, WHO HER YALE WOMEN'S HEALTH RESEARCH CENTER PLAYED A PROMINENT ROLE, I SHOULD SAY, I DON'T KNOW IF IT WAS THE EXCLUSIVE ROLE, BUT I DO KNOW THEY PLAYED A VERY PROMINENT ROLE IN FUNDING THIS WORK. AND I CAN SPEAK FROM MY OWN EXPERIENCES, SOME OF THE GRASS ROOTS EFFORTS THAT CAN OCCUR AT WOMEN'S HEALTHCARE CENTERS AND ACADEMIC INSTITUTIONS ARE SOMETIMES THE BEST WAY THAT WE CAN GET THE INITIAL OBSERVATIONS FUNDED TO THEN GO AFTER NIH MONEY FOR THIS TYPE OF WORK, SO I REALLY THINK THAT GRASS ROOTS EFFORT LOCALLY AT YALE, IT WAS BEAUTIFUL, IT WAS IMPORTANT AND IT RESULTED IN A LOVELY PUBLICATION THAT MYSELF AND OTHERS HAVE REALLY TRIED TO HIGHLIGHT. SO AS DR. CLAYTON POINTED OUT AND I JUST WANT TO KIND OF HIGHLIGHT JUST A LITTLE BIT DIFFERENTLY, IT WASN'T SO MUCH ABOUT THE NUMBERS OF CELLS. SO WHEN THEY LOOKED AT NUMBERS OF T-CELLS, CD8 REFERS TO A RECEPTOR THAT SAYS THESE ARE KILLER T-CELLS, THEY'RE REALLY GOOD AT KILLING VIRALLY INFECTED CELLS, IT'S NOT THAT WOMEN OR MEN OR MALE OR FEMALE -- PT STANDS FOR PATIENT, HCW, THOSE WERE THE CONTROL GROUPS, HEALTHCARE WORKERS. THE DIFFERENCE WAS MORE IN THE ACTIVITY. IT WAS THAT THEY WERE SEEING GREATER ACTIVITY OF THESE CELLS. WHICH I THINK BECOMES REALLY IMPORTANT. SO THERE'S SOMETHING TRANSCRIPTIONALLY PROBABLY DIFFERENT ABOUT THESE CELLS IN WOMEN OR FEMALE PATIENTS, I SHOULD SAY, AS COMPARED WITH MALE PATIENTS. THE OTHER THING I FIND VERY INTERESTING ABOUT THEIR OBSERVATION, IF WE LOOK AT THE BOTTOM PANELS, AGAIN, ON THE Y AXIS, THESE ARE JUST DIFFERENT MARKERS OF ACTIVITY OF THESE T-CELLS. WHAT THEY FOUND IS THAT THE ACTIVITY OF THESE T-CELLS REMAINS CONSTANT FOR WOMEN WITH AGE SO AS THESE WOMEN OF DIVERSE AGES WERE COMPARED, THE RESPONSE WAS HIGH AND IT REMAINED HIGH REGARDLESS OF THE AGE OF THESE FEMALE PATIENTS WHEREAS YOU SAW IN AGE ASSOCIATED DECLINE THAT WAS MORE PRONOUNCED AND STATISTICALLY SIGNIFICANT FOR MEN. IN MENOPAUSE, EVERYTHING IS GOING TO CHANGE, BUT YOU'RE NOT SEEING AGE ASSOCIATED CHANGE IN WOMEN BUT YOU ARE IN MEN. ARE THEY GENETIC, ARE THEY ENVIRONMENTAL? IT STILL COULD BE HORMONAL. BUT WHAT ARE THOSE FACTORS? SO MY GROUP, WE'RE VERY INTERESTED IN THE ANTIBODY RESPONSE, WHICH IS THE OTHER ARM OF THE ADAPTIVE IMMUNE RESPONSE, AND I'M VERY INTERESTED IN ANTIBODY RESPONSES BECAUSE OF MY INTEREST IN VACCINES, AND ANTIBODY IS OFTEN CONSIDERED KIND OF THAT GOLD STANDARD FOR MEASURING THE EFFICACY OF A VACCINE AND HOW WELL A VACCINE MAY ACTUALLY PROTECT US. THIS IS MY VERSION OF STARTING TO TRY TO ARM OURSELVES FOR MAYBE SCORE PART 2 TO REALLY BE STARTING TO THINK ABOUT THE RESPONSES TO THE COVID-19 VACCINE. IN THIS PARTICULAR STUDY, A VERY COLLABORATIVE STUDY THAT'S A PART OF THE -- WE TOOK CONVALESCENT PLASMA FROM RECOVERED PATIENTS AND WE MEASURED THEIR IMMUNE RESPONSE WITH A LOT OF DIFFERENT ASSAYS. THE ANTIS1IGG IN THAT FIRST COLUMN, THAT'S JUST A KIT THAT'S AVAILABLE, A CLIA TESTED AND APPROVED KIT THAT WE CAN USE TO MEASURE ANTIBOO DE, AND THEN I HAVE MY OWN HOME GROWN THAT ARE MUCH MORE SENSITIVE BUT NOT CLIA APPROVED, THEY CAN MEASURE THE RECEPTOR BINDING DOMAIN AND THAT'S WHAT ACE 2 BINDS TO. SO WE REALLY CARE ABOUT THAT PARTICULAR REGION. SO WHEN WE'RE MAKING OUR OWN ASSAYS, WE CAN REALLY GET A LITTLE BIT MORE SPECIFIC. AND THEN NEUTRALIZING ANTIBODY, NT, THOSE ARE ACTUALLY GOING TO NEUTRALIZE VIRUS AND PREVENT IT FROM INFECTING YOUR CELLS. THAT'S WHAT WE WANT A VACCINE TO INITIATE. AND SO ACROSS THE BOARD, WHAT WE FOUND IS THAT IN CONTRAST TO MY INITIAL HYPOTHESIS, MALES HAD SIGNIFICANTLY GREATER ANTIBODY RESPONSES NO MATTER HOW WE MEASURED THE ANTIBODY IN FEMALES. OLDER INDIVIDUALS HAD GREATER ANTIBODY ACROSS THESE DIVERSE MEASURES THAN YOUNGER INDIVIDUALS. PEOPLE WHO WERE HOSPITALIZED BUT RECOVERED HAD GREATER ANTIBODY THAN THOSE WHO WERE NOT HOSPITALIZED. WE REALLY DIDN'T SEE AN IMPACT OF TIME SINCE PCR POSITIVE TEST ON MOST OF THE MEASURES SO I'M GOING TO SKIP OVER THAT. SO HERE ARE THESE DATA COMPILED TO REALLY MAKE THIS POINT, THAT BEING MALE, BEING OLDER AND BEING HOSPITALIZED WERE ASSOCIATED WITH GREATER ANTIBODY RESPONSES IN PATIENTS WHO HAD RECOVERED FROM INFECTION. SO WHAT WE ENDED UP DOING WITH OUR DATA WAS PLACED ALL PEOPLE INTO QUARTILES BASED ON THEIR RESPONSE. SO YOU WERE EITHER IN THE LOWEST QUARTILE FOR ONE OF THESE DIFFERENT MEASURE OF ANTIBODY OR YOU WERE IN THE HIGHEST. IF YOU WERE IN THE LOWEST, YOU RECEIVED A SCORE OF ZERO, AND WE HAD 16 OF OUR 126 PATIENTS THAT FELL INTO THIS CATEGORY. IF YOU WERE SOMEBODY WHO WERE IN THE HIGHEST QUARTILE FOR ALL FOUR MEASURES OF ANTIBODY, YOU GOT A SCORE OF A 12. AND WE HAD 17 PEOPLE IN THAT CATEGORY. THEN DEPENDING ON WHICH QUARTILE A PATIENT FELL INTO FOR EACH OF THE DIFFERENT RESPONSES, YOU FELL INTO ANY OF THE RANGE FROM ZERO TO 12. SO IF WE Q.GO AND LOOK AT THE ADJUST THE COEFFICIENTS, WHAT WE FOUND WAS THAT JUST BEING MALE COULD INCREASE YOUR SCORE ON A 12-POINT SCORE BY 1.5 POINTS. BEING OLDER WAS NOT AS SIGNIFICANT, A LESS THAN ONE-POINT INCREASE, BUT BEING HOSPITALIZED COULD INCREASE YOUR SCORE BY OVER FIVE POINTS. SO I DO THINK THESE ARE SOME OF THE FACTORS THAT WE COULD BE PAYING MORE ATTENTION TO TO BETTER UNDERSTAND PROGRESSION OF DISEASE. DESPITE HAVING THESE GREATER ANTIBODY RESPONSES, MALES ARE SHEDDING MORE VIRUS AND FOR LONGER DURATION OF TIME. I'VE ONLY SEEN THIS IN SEX-DISAGGREGATED DATA PERTAINING TO THE VIRUS COMING OUT OF THE EARLY STUDIES OUT OF WUHAN, CHINA. SO YOU KNOW, I'LL CALL OUT THAT MORE OF US NEED TO BE DOING THIS TO SEE IF THIS IS STILL HOLDING UP. BUT I DO THINK THAT IT'S IMPORTANT FOR US TO BE LOOKING AT THE VIRUS, LOOKING AT THE IMMUNE RESPONSE AND NOT ONLY STUDYING THE IMMUNE RESPONSE IN THE CONTEXT OF HOW IT'S PROTECTING US BUT HOW IT MAY BE BEING DRIVEN BY ABILITY TO CONTROL THE INFECTION AND MAY CONTRIBUTE TO SOME OF THE PATHOLOGIES INCLUDING SOME OF THOSE LONG TERM PATHOLOGIES THAT HAVE BEEN DISCUSSED EARLIER TODAY. I DO NONE OF THIS IN ISOLATION. I WORK WITH TREMENDOUS WONDERFUL PEOPLE. I WILL POINT OUT THE SLIDE HERE IS PRECOVID, SO NO SOCIAL DISTANCING, NO MASK, WHICH LOOKS SO STRANGE TODAY, BUT I AM THANKFUL FOR MY SCORE FUNDING. IT REALLY PUT US IN A WONDERFUL PLACE FOR ADMINISTRATIVE SUPPLEMENTS AND TO RECEIVE FROM THE NATIONAL CANCER INSTITUTE A SEROLOGICAL CENTER OF EXCELLENCE WHERE SEX AND GENDER ARE A VERY MAJOR PART OF OUR ANALYSES AND SO WITH THAT, I WILL END. THANK YOU. >> THANK YOU VERY MUCH, DR. KLEIN, FOR THAT REALLY COMPREHENSIVE AND SO CLEAR, I MEAN, YOU JUST REALLY BREAK IT DOWN IN A WAY THAT IS VERY ACCESSIBLE, SO REALLY GREATLY APPRECIATE THAT, ESPECIALLY BECAUSE THIS IS A PUBLIC MEETING AND WE DO WANT EVERYBODY TO BE ABLE TO UNDERSTAND HOW IMPORTANT THIS IS. >> THANK YOU. >> AND WE ARE RIGHT AT 12:00, BUT I THINK THAT THERE IS ONE QUESTION. >> SOUNDS GOOD. >> DR. SIDOFSKY IS ASKING ARE THERE ANY DIFFERENCES IN MISC RESPONSE? I'M NOT SURE WHAT HE'S TALKING ABOUT. >> I'M NOT EITHER. >> ARE YOU TALKING ABOUT THE PEDIATRIC CONDITION? >> YEAH, I'M TALKING ABOUT THE MULTISYSTEM -- I LOVE IT. THANK YOU. WONDERFUL QUESTION. I DON'T KNOW IS THE ANSWER. I DON'T KNOW. BECAUSE ONE OF THE LARGEST PEDIATRIC PATIENT STUDIES TO BE PUBLISHED, IT'S ABBREVIATED BRAVE, IT IS A WONDERFUL STUDY, THEY DID NOT DISAGGREGATE THEIR DATA TO COMPARE BOYS AND GIRLS. >> SO THAT REALLY HIGHLIGHTS, AGAIN, HOW IMPORTANT IT IS TO DO THAT. >> YES. >> BUT SABRA, CAN YOU COMMENT ON THE REPORT OUT OF FRANCE WITH THE HIGHER NUMBER OF WOMEN IN THE LONG HAULERS? >> YES, YES. SO I THINK IN MANY CASES, AS YOU PUT IT AND AS WERE DESCRIBED BY OUR PREVIOUS SPEAKER, THESE LONG HAULERS, THE PEOPLE WHO ARE EXPERIENCING SOME OF THE MORE CHRONIC, LONGER TERM SYMPTOMS BEING WOMEN, AND YOU KNOW, WE'RE PROBABLY GOING TO HEAR A LOT ABOUT GENDER ASSOCIATED FACTORS THAT COULD GO INTO THAT, BUT AS A BIOLOGIST, I WANT TO PUT A PLUG IN FOR SOME OF THE BIOLOGY, AND I WANT TO SHARE WITH YOU AND OTHERS ON THIS CALL THAT WE ACTUALLY SEE THAT IN CASES WHERE OUR IMMUNE SYSTEM CONTRIBUTES TO SOME OF THE PATHOLOGIES, ACROSS THE BOARD WE SEE THIS TO A GREATER EXTENT IN WOMEN AS COMPARED WITH MEN. AND I THINK THE CONCEPTS BROUGHT UP BY THE LAST SPEAKER THINKING ABOUT RECOVERY, WE AND OTHERS HAVE SHOWN THAT FEMALES, AND THIS IS TRUE IN MICE AS WELL AS HUMANS, AND I POINT OUT THE MOUSE BECAUSE WE GET TO ELIMINATE SOME OF THE GENDER-ASSOCIATED FACTORS THAT CAN GO INTO OUR INTERPRETATIONS OF HUMAN EPIDEMIOLOGICAL OBSERVATIONS. BUT THAT RECOVERY, YOU KNOW, SO WE GET THOSE REALLY ROBUST INFLAMMATORY RESPONSES, BUT THEN SHUTTING THOSE OFF WHEN THEY'RE NO LONGER NEEDED IS WHERE WE RUN INTO PROBLEMS, AND YOU TEND TO SEE MORE CHRONIC INFLAMMATION. AT LEAST AMONG ADULTS. I CAN'T -- YOU KNOW, I DON'T KNOW ABOUT PEDIATRIC, BUT DEFINITELY ADULTS. >> THANK YOU SO MUCH, SABRA. YOU MAY GET QUESTIONS IN THE CHAT LATER IN THE DAY BECAUSE WE'RE A LITTLE OVER. I'M JUST GOING TO GO AHEAD AND ADJOURN OUR MORNING, BUT WE DO NEED ALL OF OUR MEMBERS. IF YOU WOULDN'T MIND, PUT YOUR VIDEO CAMERAS ON SO WE CAN TAKE A VIRTUAL GROUP PHOTO AND FOR ALL OF OUR ATTENDEES, WE'RE GOING TO BE ADJOURNED FOR LUNCH AND MEET YOU BACK HERE. PLEASE JOIN US BACK HERE AT 1:00. SARAH OR MICHAEL, I'M NOT SURE WHO'S DOING THE PHOTO. BUT IF YOU WOULD GO AHEAD AND DIRECT US. >> YES. I WILL BE TAKING THE PHOTO. I WILL WAIT UNTIL EVERYBODY HAS THEIR VIDEO ON. I'LL HAVE TO TAKE A COUPLE BECAUSE WE'VE GOT TWO SCREENS WORTH OF PRESENTERS BUT I'LL JUST WAIT FOR THE LAST OF US TO GET OUR VIDEO ON. >> NO WORRIES. HI, DR. WOOD. HI, GOOD TO SEE YOU. >> IT LOOKS LIKE I HAVE EVERYBODY ON THAT CAN JOIN. SO IF EVERYBODY WANTS TO SMILE FOR ME? ALL RIGHT. WE SHOULD BE GOOD. THANK YOU GUYS SO MUCH. BE BACK HERE AT 1:00. >> I'D LIKE TO CALL THE MEETING BACK TO ORDER AND HAND THE FLOOR OVER TO A HEALTH SCIENCE HERE AT ORWH AND HE WILL BE INTRODUCING OUR NEXT SPEAKER. >> THANK YOU, LIZ. GOOD AFTERNOON. IT IS MY HONOR TO WELCOME DR. BRUCE TROMBERG THE DIRECTOR OUR OF THE NATIONAL INSTITUTE OF NIBIB. CAN YOU GUYS HEAR ME? >> YES. >> YOU ARE FINE. >> OK. HE OVERSEES 400 MILLION PORTFOLIO OF RESEARCH PROGRAMS FOCUSED ON DEVELOPING, TRANSLATING AND COMMERCIALIZING ENGINEERING FISCAL SCIENCE AND COMPUTATIONAL TECHNOLOGIES IN BUY LODGE' AND MEDICINE AND IN ADDITION, HE LEAVES THE NIH $500 RAPID DIAGNOSTICS WHICH IS RADX INNOVATION INITIATIVE TO INCREASE SARS-CoV-2 TESTING CAPACITY AND PERFORMANCE. DR. TROMBE RG HAS BIOMEDICAL IMAGING AND THERAPY. HE HAS CO AUTHORED 450 PUBLICATIONS AND HOLDS 21 PATENTS IN NEW TECHNOLOGY DEVELOPMENT AND BENCH TO BEDSIDE VALIDATION AND COMMERCIALIZATION OF DEVICES. HE HAS TRAINED 80 STUDENTS AND FELLOWS AND CO-FOUNDER OF BIO COMPANY INCORPORATED AND HAS SERVED ON NUMEROUS ADVISORY BOARDS IN ACADEMIA AND GOVERNMENT AND PRIVATE FOUNDATIONS. PLEASE, JOIN ME IN WELCOMING DR. TROMBERG. >> THANK YOU SO MUCH. CAN YOU HEAR ME AND SEE MY FIRST SLIDE? >> YES. >> OK. GREAT. AND NOW I'LL JUST GO INTO PRESENTATION MODE. THANK YOU ALL. IT'S JUST GREAT TO BE BACK WITH YOU AGAIN AND HAVE THIS OPPORTUNITY TO PRESENT AN UPDATE ON WHAT WE'RE DOING WITH RADX. IF YOU HAVEN'T HEARD OF IT, HOPEFULLY BY THE END OF THE PRESENTATION YOU WILL BE EXCITE BID WHAT WE'RE DOING AND THE AMBITION AND THE WAY THAT THE COUNTRY IS COMING TOGETHER TO HELP BOTH DEVELOPMENT AND IMPLEMENT AND DEPLOY NEW TESTING TECHNOLOGIES AND JEANNINE, THANK YOU FOR IN INVITING ME. IT'S GREAT TO BE WITH YOU TODAY. FROM A RADX TECH AND ATP POINT OF VIEW, A LITTLE BIT OF BACKGROUND. THESE ARE TWO OF WHAT I WOULD LIKE TO CALL THE TOTALLY RADX NIH. THERE'S RAD X TECH, RAD XATP AND UP AND RADX RAD SO WE HAVE A NUMBER OF PROGRAMS AT THE NIH THAT ARE SUPPORTED THROUGH THE VERY GENEROUS FORWARD CONGRESSIONAL SUPPLEMENT THAT WAS $1.5 BILLION SUPPLEMENT TO NIH AND $500 MILLION OF THAT WENT TO NIBIB. IT'S QUITE A SURPRISE, BECAUSE AS WAS POINTED OUT, WE'RE NORMALLY 400 MILLION-DOLLAR A YEAR ORGANIZATION SO, IN SUPPLEMENTS AND IN ADDITIONAL FUNDS THAT WERE CHARGED WITH SPENDING ON THIS PANDEMIC CRISIS, WE ARE EXCEEDING THE TOTAL ANNUAL BUDGET OF OUR INSTITUTE AND IT'S BEEN QUITE AN INTERESTING CHALLENGE AND WE'RE WORKING, OF COURSE, VERY CLOSELY WITH ALL OF NIH LEADERSHIP, DOCTORS COLLINS, AND TAYBACK AND SCHWETZ AND DR. FLORENCE WHO HAS BEEN BROUGHT ON JUST TO REALLY HELP STAND UP THESE PROGRAMS. AND THE DEPUTY DIRECTOR OF NIBIB AND MYSELF ARE LEADING THE TECH AND THE ATP INITIATIVES. THERE'S QUITE A LOT OF PARTICIPATION ALL ACROSS THE NIH AND AS YOU CAN SEE, FROM A RECENT NEW ENGLAND JOURNAL ARTICLE THAT DESCRIBES THESE PROGRAMS. SO I WILL FOCUS ON THE TECH AND THE ATP PLATFORMS AND IN ORDER TO MAKE ALL OF THIS HAPPEN, WE'RE ALSO WORKING VERY CLOSELY WITH THE ASSISTANT SECRETARY OF HEALTH, THE FDA, DEPARTMENT OF DEFENSE, ALL ACROSS THE HHS, THERE'S REALLY UNPRECEDENTED COLLABORATION AND SOMETHING INTERESTING TO POINT OUT. WE RECEIVED THIS APPROPRIATION ON APRIL 24th, AND YOU CAN IMAGINE WE REALLY HAD TO WORK VERY HARD BECAUSE WE LAUNCHED A APRIL ON APRIL 29th, THE FASTEST TIME TO APPROPRIATION TO PROGRAM LAUNCH IN THE HISTORY OF THE NIH. THAT I THINK SUMMARIZES WHAT WE'VE BEEN ABLE TO DO. IT'S ALL ABOUT ACCELERATION, ACCELERATION, ACCELERATION. AND I'LL TALK ALL ABOUT THAT. THE OVER ARCHING GOALS OF THESE TWO PROGRAMS ARE TO EXPAND THE TESTING TECHNOLOGIES IN A NUMBER OF TECHNOLOGIES AND THE TYPE AND ACCESSIBILITY TO THEM AND WE'RE THINKING WE'RE TRYING TO SUPPORT AND NURTURE BOTH TECHNOLOGICAL AND OPERATIONAL PERFORMANCE OF THE TECHNOLOGY. THE ESSENCE IS TO THINK ABOUT A COMMUNITY THAT NEEDS IT AND TRY TO HAVE THE DEVELOPMENT OF THE TECHNOLOGY THAT MATCHES THE NEEDS OF THOSE COMMUNITIES. THE SETTINGS SPAN FROM HOME TO POINT OF CARE AND TO LAB BOTH CLEO LABS AND RESEARCH LABS. IF YOU LOOK ON THE RIGHT. THIS IS OUR -- IN AUGUST WE WERE DOING 800,000 TESTS A DAY AND IF YOU DON'T TOP A GOVERNMENT-DRIVEN PROGRAM THERE'S ALWAYS GROWTH IN THE COMMERCIALIZATION SECTOR DRIVEN BY MARKETS AND THAT GROWTH WOULD BE QUITE MODEST. IT WOULD CONTINUE OVERTIME AND IT WOULD NOT BE ENOUGH TO MEET THE NEEDS OF THE COUNTRY, WHICH ARE ESTIMATED TO BE IN THE SIX TO 10 MILLION TESTS PER DAY BALLPARK. WORE TRYINWE'RE TRYING TO SCALE UP NOVEL EXISTING TECHNOLOGIES AND ALSO DRIVE NOVEL TECHNOLOGIES, WE STARTED OUT IN THE PROGRAM WHERE LAB APPROACHES ARE IN TERMS OF TESTING PER DAY, ARE MUCH GREATER, MUCH MORE FREQUENT THAN CARE. AND WHERE WE ANTICIPATE SEEING AND DRIVING THE COUNTRY, OVER THE NEXT SEVERAL MONTHS, AND THE NEXT YEAR, IS THE EMERGENCE OF POINT OF CARE OPTIONS AND THEY WERE MANY, MANY MORE POINT OF CARE OPTIONS AND AS WE CONTINUE TO PROGRESS THROUGH THE END OF THE YEAR AND NO NEXT YEAR AND AS RESULT OF THIS PROGRAM. THE WAY WE LAUNCHED THIS, THIS STRUCTURE IS A SERIES OF PHASES AND STAGES WHERE EVERY PROJECT IS REVIEWED INTENSIVELY AND CAN BE PROMOTED OR ACCELERATED TO THE NEXT PHASE. AND 136 WERE SELECTED FOR SOME OF YOU MAY HAVE HEARD OF AS A SHARK TANK PHASE OR A DEEP DEPTH THAT INVOLVES AROUND A WEEK TO TWO WEEKS AND INTENSIVE ANALYSIS AND REVIEW WHERE THEY PROPOSING PROJECT TEAM IS MATCHED WITH THE TEAM OF EXPERTS, TECHNOLOGY, CLINICAL, COMMERCIALIZATION, MANUFACTURING EXPERTS AND THE CONCEPT IS REVIEWED INTENSELY AND WHAT EMERGES AND MILESTONES AND A BUDGET POSSIBLY UP TO A MILLION DOLLARS, FOR THE INITIAL VALIDATION AND DERISKING. FROM THAT, 136, 46 WERE SELECTED FOR THAT PHASE 1 VALIDATION AND RISK REVIEW PROCESS AND THEN NOW WE HAVE 22 THAT WERE SELECTED FROM THAT GROUP TO RECEIVE MANUFACTURING AND SCALE-UP FUNDING THAT IS A PHASE 2. WHERE THEIR FURTHER CLINICAL PERSPECTIVE TESTS, REGULATORY APPROVAL, AND TRUE EDITION OF MANUFACTURING LINES AND SO CHARACTERISTIC AND THE NIH AND WE HAVE GONE ALL THE WAY IN A VERY, VERY SHORT TIME PERIOD. THIS NORMALLY TAKES MAYBE FIVE OR SIX YEARS AND WHAT WE'VE BEEN ABLE TO DO WITH THE EMERGENCE OF OUR FIRST GROUP, IS COMPRESS THIS NO A FIVE SO SIX MONTH AND WE'VE SPENT IN THIS PHASE 2 PART SO FAR, ALMOST $500 MILLION AND IT'.SO THIS INNOVATION FUNNEL HAS PRODUCED INTERESTING TECHNOLOGIES, EXCITING TECHNOLOGIES THAT WE THINK ARE GOING TO HAVE GREAT IMPACT AND WE'RE ALREADY HAVING A GREAT IMPACT IN TERMS OF THEIR DEPLOYMENT. ON THE LEFT SIDE OF THE SCREEN, YOU CAN SEE SEVERAL DIFFERENT PCR TYPES OF APPROACHES LOOKING AT MECHANISM WHAT THEY'RE MEASURING THE CONCENTRATION OF. ON THE RIGHT SIDE, YOU CAN SEE A COUPLE OF LATERAL FLOW ASIZATION AT THE TOP THERE'S A TIP DICK AND AND ON THE UPPER RIGHT AND I'LL ACTUALLY PULL THIS OUT AND YOU CAN SORT OF SEE THE SCALE OF IT. THIS IS AN EXAMPLE BASED ON A LITTLE THESE GOES NO A MOBILE DEVICE AND EACH CARTRIDGE CAN BE USED FOR COVID ASSAY OR ANTIBODY ASSAY AND THIS IS A PERSONAL POTENTIALLY HOME BASED ASSAY THAT THIS COMPANY AND WHICH IS PARTNERING WITH CYOGEN IS DEVELOPING AND THERE'S A TYPE OF AN ASSAY BUILT INTO AND DEDICATED TO A MOBILE UNIT, A VAN, AND THIS IS INTENDED TO BE ABLE TO BE WE'RE SEEING FROM A TECHNICAL POINT OF VIEW, INTRODUCTION OF GREAT IDEAS AND HOW YOU SEPARATE VIRUS FROM THE SWAB AND GET IT INTO YOUR TESTING DEVICE AND WE'RE SEEING INNOVATIONS AND CHRIS PER AND AND THERE ARE BEAUTIFUL REPORTERS AND SO BASICALLY LEVERAGING YOUR TELEPHONE AND LOTS OF AND IT BRINGS OUT THE COMMUNITY WE HOPE TO INSPIRE TO HELP TO DEVELOP THOSE THINGS ON A RAPID BASIS. THE 17 OF THESE ASSAYS FROM THESE COMPANIES ARE KNE NUCLAIC ACID AND IT'S POINT OF CARE TO LABORATORY AND TO OUR POINT OF CARE. THREE OF AN INTERESTING IN BETWEEN STATE WHERE THEY'RE NOT YOUR TYPICAL LARGE LAB MACHINE BUT THEY'RE MODEST SIZE MACHINE. SOME OF THEME BEING BAT RYE POWER AND THE DEPLOYED IN THE LAB SITTING AND MULTIPLE TEST AS THROUGH PUT BUT THEY'RE SMALL ENOUGH FORM FACTORS AND PORTABLE ENOUGH THAT THEY CAN BE TAKEN TO DIFFERENT SETTINGS AND 11 OF THESE ARE LAB SETTINGS WHERE WE HAVE SEVERAL THAT ARE CAPABLE OF DELIVERING UP TO 100,000 TESTS PER DAY AND NOTABLE THERE AND ARE THE NEXT-GEN SEQUENCES FROM HELIX AND' LUMINA AND A TEST AND I'LL HOLD THAT LITTLE CHIP AND IT'S POSSIBLE TO FEED THEIR PLATFORM AND MANY OF THESE CHIPS OVER THE COURSE FOR EACH SAMPLE AND INCREASE YOUR NUMBER AND FACTOR OF FOUR AND UP TO A FACTOR OF EIGHT AND REALLY EXCITING APPROACHES AND ALREADY AND THE TECHNOLOGIES HAVE AND WHAT EACH OF THESE GROUPS IS DOING IN THE VALIDATION AND CLINICAL STUDIES COURSE WHICH SECOND AND THEY'RE GETTING ALL THE OF THE DATA FOR SUBMISSION OF REGULATORY APPROVAL AND THE IMPACT OF ALL OF THIS IS THAT WE EXPECT BY THE END OF THE YEAR, THIS COHORT OF 22 WILL CONTRIBUTE ABOUT TWO AND A HALF MILLION TESTS PER DAY TO THE NATIONAL CAPACITY AND AND ONE IS ACTUALLY A VOLATILE TEST WHICH IS QUITE INTERESTING WHERE YOU BREATHE IN A TUBE AND ALMOST INSTANTANEOUSLY HAVE QUALITY INDICATION OF DETECTION. IT'S HARD TO SAY IF THEY'LL MAKE IT INTO PHASE 2 BUT THAT'S WHAT THE WHOLE GOAL IS TO FIND OUT. THERE'S A SUMMARY I HAVE THIS URL ON THE SLIDES WHICH ALL OF YO.IT WAS CONDUCTED AROUND THE NETWORK CALLED THE POINT OF CARE TECHNOLOGIES NETWORK, RESEARCH NETWORK, AND WHAT WE'VE DONE IS EXPAND THIS NETWORK SOMEWHAT, I WOULD HIJACK IT AND PERHAPS AGAINST THE WILL OF THE INVESTIGATORS, WHO WERE DOING MANY OTHER THINGS IN POINT OF CARE TECHNOLOGIES, BUT, AROUND THE BEGINNING OF APRIL, WE RECOGNIZED SHALL END OF MARCH, WE RECOGNIZED THAT THERE WOULD BE REALLY QUITE CRITICAL TESTING NEEDS FOR THE COUNTRY AND BEGAN DISCUSSING THIS WITH THE NETWORK. AND CONSTRUCTED, OVERTIME, THE ABILITY TO HAVE MULTIPLE FEATURES BUILT INTO THIS NETWORK AND WE'RE CONTINUING TO GROW IT AND BUILD OUR COLLABORATIONS WE HAVE NON PROFITS AND VENTURE WELL AND BIO COM SO THIS CENTER ORGANIZING UNITS OF THE NETWORK IS IF YOU LOOK ON THE RIGHT SIDE OF THE SCREEN, A CORE, WHICH IS A GEORGIA TECH EMERY THAT VALIDATES THE TECHNOLOGIES AND DERISKS THEM. EVERY PROJECT THAT GOES THROUGH HAS TO GO THROUGH ITS OWN INDEPENDENT TESTING AND VALIDATION. WE HAVE A CLINICAL TESTING CORE THAT ALLOWS US TO DO STANDARD TRIAL DESIGN AND TEST DIGITAL HEALTH PLATFORMS WITH THE SINGLE IRB AND THE CENTER NETWORK AT U MASS AND THEY UNDERSUPPLY CHAIN, MANUFACTURING CAPABILITIES AND REACHING OUT TO THE USER COMMUNITY AND DEVELOPING END-TO-END SOLUTIONS SO ALL OF THIS IS STITCHED TOGETHER TO REVIEW FUNDING AND PROVIDE NECESSARY EXPERTISE OR PROJECTS AND TO TEST AN EVALUATE PERFORMANCE AND YOU'VE SEEN THE RADXUP PROGRAM ANNOUNCED AND LAUNCH. THERE'S THE CDC AND THAT IS NOW CONNECTED TO RADX TECH THROUGH OUR COORDINATING CENTERS. SO THE DUCK, UNC, CDC IS CONNECTED TO SUMMIT AND MGH IN ORDER TO PROVIDE THE RADX KEY COMMUNITY, WITH THE LATEST FOR EVERYTHING DONE IN THE RADXUP STRUCTURE. JUST A FEW SNAPSHOTS OF HOW THESE WORK THE VALIDATION CORE AT EMERY G GEORGIA TECH AND PERFORMANCE OF EACH TECHNOLOGY, THESE ARE STANDARDIZED AND DONE IN COLLABORATION WITH THE FDA AND THIS IS AN EXAMPLE OF THE KIND OF THING THAT COMES OUT WHERE THERE'S QUITE A DETAILED REPORT USING NIH TECHNOLOGY AND OVER ALL VISUAL SNAPSHOT OF THE PERFORMANCE AND THE LIMIT OF DETECTION, THESE ARE IN CONTRIVED SAMPLES AND THERE ARE THREE DIFFERENT TYPES THAT ARE EXPLORED AS WELL AS IN SMALL SCALE PERSPECTIVE CLINICAL STUDIES THROUGH A DRIVE-UP. THEY HAVE MASTER PROTOCOLS. OUR STUDIES HAVE 250 SUBJECTS AND THEY'RE DESIGNED TO BE ABLE TO SWAP WITH THESE IRB PROTOCOLS IN AND TOUT AS THEY COME UP FOR ANALYSIS. AND THERE'S A DIGITAL HEALTH PLATFORM AND IT'S CONNECTED ACROSS THE COUNTRY TO OUR CTSAs AS WELL AS THE TO THE POCTRN NETWORK AND THIS IS AN IMPORTANT COMPONENT OF THE PROCESS. AT THE BEGINNING, OF COURSE, WE HAD FEW TECHNOLOGIES THAT WERE EMERGING BUT NOW AS THESE COME OUT THEY HAVE EUAs AND WE'RE TRYING TO BEST DOUGH PLOY WHAT IS THE GUIDANCE FOR A PLATTERRAL PLOLATERALFLOW ASSAY AND THIS IS A IMPORTANT PIECE OF THAT. WE HAVE A CORE IF TERMS OF NETWORKS OVER 30 DIFFERENT MEMBERS LED BY NANCY AND SHE IS AN EXPERT IN THIS, A FORMER CHIEF MEDICAL OFFICER AT CVS AND HART OF THAT THEY DISCUSS ARE SUPPLY CHAIN AND COMPUTATIONAL MODELS THAT ARE DEVELOPED TO HELP UNDERSTAND AND EVALUATE WHEN. >> WHEN TO TEST THE AN LET CAL PERFORMANCE BUT WHAT IS THE COST OF TESTING FOR YOUR COMMUNITY OR YOUR INSTITUTION AND WHAT'S THE RETURN ON THAT INVESTMENT. FINALLY THE LAST THING I'D LIKE TO HIGHLIGHT IS OUR EFFORTS WOVE BEEN WORKING CLOSELY WITH THE NATIONAL CANCER INSTITUTE ON THIS AND TO SUPPORT DIGITAL HEALTH NETWORK AND PLATFORMS THAT CAN BE DEPLOYED IN THE FORM OF APPS AND THEY WILL PLAY A VERY CENTRAL ROLE IN THIS WHOLE PROCESS OF BEING ABLE TO ULTIMATELY BRING TESTS INTO PEOPLE'S HOMES BECAUSE THE TEST, AS YOU CAN SEE ON THE LEFT SIDE OF THE SCREEN, IS JUST ONE OF MANY INPUT DEVICES CAN ACTUALLY I'VE GOT, BECAUSE I HAVE A WHOLE ARSENAL OF THESE TESTS AT HOME, THIS IS A HAPPENED-HELD RTPCR WITH A REMOVABLE CARTRIDGE AND THE COST OF GOODS OF THE TEST IS ABOUT $300, THE CART REGINA IS ABOUT $20 TO $25, SO IT'S BEGINNING TO MOVE INTO A HIGH FREQUENCY SETTING. THE OUTPUT OF THIS CARTRIDGE CAN BE READ WITH THE SMARTPHONE AND THE GATES FOUNDATION WE WORKED CLOSELY WITH, TO DEVELOP TYPES OF READERS AND INTEGRATE THAT INTO THESE DIGITAL HEALTH PLATFORMS. THE INFORMATION IS COMBAT ABLE WITH HL7 SO THIS IS PORTED OVER INTO CLINICAL NETWORKS AND THE PARTICULAR PLATFORM CAN BE CONNECTED OUT OF THE BOX WEARABLES THAT HAVE LOTS OF VALUE IN FOLLOWING SYMPTOMS THERE'S A LOT OF WORK TO UNDERSTAND THE VALUE OF DIGITAL AND CONTACT TRACEING AND WE'VE BEEN WORKING WITH APPLE AND COOLING GOOGLE ON THE BLUE TOOTH AND TURN THIS OUT IN A PRIVACY-PRESERVING WAY TO GIVE YOUR PROOF OF HEALTH STATUS. SO THAT IS A KIND OF INTEGRATION SYNTHESIS VISION. LET ME SUMMARIZE WITH ALL OF THIS. THE TECHNOLOGIES WE'RE DEVELOPING WITHIN RADX AND ATP AND TECH ARE MULTIPLE PLATFORMS AND CAPABLE OF DELIVERING MILLIONS OF TESTS PER DAY AND I HAVE A LOT OF CONFIDENCE IN THE TECHNOLOGY COMMUNITY TO BE ABLE TO CONTINUE TO DO THIS AND EXPAND IT. WITH THE BIGGEST CHALLENGE OF COURSE, AND PROBABLY I THINK MANY OF YOU KNOW THIS, IS THAT THIS IS QUITE DIFFERENT FROM THE WORLD OF STANDARD MEDICAL DIAGNOSTICS WHERE EVERYTHING IS DESIGNED TO DETECT AND DIAGNOSE DISEASE IN AN INDIVIDUAL AND USE THAT INFORMATION TO TREAT THAT INDIVIDUAL WHETHER YOU ARE LOOKING FOR CANCER OR HEART DISEASE AND ANY OTHER UNDERLYING COMMUNITY AND IT'S ALL ABOUT RETURNING A MEDICAL DIAGNOSTIC TO THAT INDIVIDUAL AND THE PARADOX IS WE ARE CHARGED WITH ASSESSING AND TRACKING THE ABSENCE OF THE DISEASE IN LARGE ASYMPTOMATIC POPULATIONS AND THAT'S NEVER BEEN DONE BEFORE IN THIS TYPE OF SCALE. THE BARRIERS TO THIS ARE FUNDAMENTALLY ECONOMIC AND YOU GET THE DIAGNOSTIC DEVICE COMPANY OR THE HEALTHCARE PROVIDERS AND GETS PAID FOR EVERY ONE OF THOSE TRANSACTIONS AND HERE THERE NEEDS TO BE MULTIPLE TRANSACTIONS ON A DAILY BASIS THAT IS NOT NECESSARILY INFORMING AN INDIVIDUAL AND IT'S INFORMING PUBLIC-HEALTH AUTHORITIES AND INFORMING ALL OF US ON GUIDANCE OF HOW THE COMMUNITY CAN RESPOND AND SO THERE ARE A NUMBER OF ECONOMIC AND CULTURAL BARRIERS TO THIS WHICH IS IN PART WHY WE HAVE OTHER PROGRAMS LIKE RADX UP THAT ASSESS AND UNDERSTAND THOSE. IN ORDER TO REALLY TRY TO DRIVE THAT IMPLEMENTATION FORWARD, WE FORM LOTS OF PARTNERSHIPS. THOSE ARE DESIGNED TO TRY TO BUILD AND IDENTIFY GUIDELINES FOR MATCHING AND DEPLOYING THE TICK KNOWLEDGE AND PROTOCOLS FOR A RANGE OF USE CASES, BASICALLY, WHAT TESTS WE SHOULD USE AND WHEN SHOULD WE USE IT AND WE ALSO CONSTANTLY EVALUATE THE PERFORMANCE, THE TECHNICAL PERFORMANCE AND OPERATIONAL PERFORMANCE OF ALL THESE TESTS AND THEN YOU ARE SEEING OR MAYBE EVEN GENERATING YOUR OWN MODELS, MANY OF THOSE MODELS NEED TO HAVE VALIDATION ULTIMATELY SO WE'RE HOPING TO BE ABLE TO GENERATE DATA AND STUDIES THAT WILL HELP US VALIDATE THE MODELS AND ULTIMATELY, INSPIRE THE USE OF TESTING AND PLATFORMS FOR WIDESPREAD SCREENING AND SURVEILLANCE. I'LL STOP THERE AND I MAY HAVE TIME FOR SOME QUESTIONS. >> THANK YOU, BRUCE FOR THAT WHIRLWINDS OF A HUGE AMOUNT OF ACTIVITIES. I'M AWARE OF PACE THAT HAS MOVED FOR WITH SO CONGRATULATIONS TO YOU AND THE TEAM FOR THAT. LET'S SEE IF THERE ARE QUESTIONS IN THE CHAT. >> WE DON'T HAVE ANY RIGHT NOW. >> OK. OK. BRUCE, YOU WERE WITH US NOT TOO LONG AGO AND SHARED ALL THE AMAZING THINGS THAT NIBIB WAS DOING AND THAT WAS PRE-COVID IN THE WOMEN'S HEALTH SPACE. I WONDER IF YOU MIGHT COMMENT IN THE CONTEXT OF TECHNOLOGY AND THE AMAZING WORK YOU ARE DOING, WHERE I SEE PERHAPS AN OPPORTUNITY TO TAKE ADVANTAGE AND LEVERAGE POTENTIAL DIFFERENCES BETWEEN SEXES OR SEX AND G.D.P.E GENDER IN THE PROCESS AND THE LIKELIHOOD THAT SOMEONE MIGHT BE WILLING TO ENROLL IN A MOBILE TESTING VERSUS A NOT MOBILE. HAVE THOSE THOUGHTS CROSSED YOUR MIND AND WHERE DO YOU THINK MAYBE, AS THINGS ARE MOVING FORWARD, WE MIGHT BE ABLE TO INTEGRATE THAT PERSPECTIVE. >> YES, ABSOLUTELY. THANK YOU, JEANNINE. IT'S A QUESTION I WANT TO TURN BACK TO YOU AND YOUR COLLEAGUES. BECAUSE, THIS IS, AS YOU CAN SEE, WE'VE BEEN A LITTLE SURPRISED AT THE ROLE WE'VE HAD TO TAKE AND RESPOND TO AND BEEN IN OVERDRIVE MODE TO STAND UP AN OPERATION IN A SHORT PERIOD OF TIME WHICH HAS BEEN HEAVILY ORIENTED TOWARDS GETTING MORE TEST AND ABOUT BEING RIGOROUS ABOUT THE PERFORMANCE. NOW THAT WE HAVE 22 THAT ARE OUT AND I THINK WE'RE WELL ON OUR WAY, WE'RE TAKING A BREATH AND THAT IS WHY THIS WE'RE TAKING A BREATH AND SAYING OK, WE'VE REACHED OUT INTO THE RAD EX UP MET WORK AND WORKING CLOSELY WITH THEM AS THEY STAND UP AS THEIR PROGRAMS AND WE KNOW WE HAVE HEALTH DISPARITY AND COVID IS EFFECTING POPULATIONS UNEQUALLY ALL AROUND THE COUNTRY AND NOW IS THE TIME FOR US, AS THE TECHNOLOGY DEVELOPERS, TO UNDERSTAND THAT BETTER. THIS IS THE TIME THAT WE NEED TO CONNECT WITH THOSE COMMUNITIES AND TO GIVE US GUIDANCE FOR PROBLEM INSPIRED DESIGN. WE CAN FEED THAT BACK INTO THE ACTUAL TECHNOLOGY ITSELF AND BUILD ON WHAT WE'VE BEEN BUILDING OUR BIO ENGINEERING COMMUNITY ON AND NOW TRY TO ADDRESS THIS IMPRESSING NEED SO I REALLY WELCOME ALL OF YOUR RECOMMENDATIONS AND OUR IMPLEMENTATION TO WE CAN BUILD THEM OUT AND IMPLEMENT IN A WAYS THAT MAKE A DIFFERENCE. >> WE APPRECIATE THAT. DO THE MEMBERS HAVE AN IDEAS ABOUT THAT THEY CAN PUT THEIR COMMENT IN THE CHAT OR ASK FIRST AND THIS IS UNPRECEDENTED SO YOU GOT ACCESS TO THE DIRECTOR AND YOU CAN ASK HIM ANYTHING YOU WANT AND I REALLY DO APPRECIATE THAT. UNTIL WE HAVE CONNECTIONS BETWEEN THE MULTIPLE DISCIPLINES AND WORK TEAMS THAT WE'RE ALL, YOU KNOW, REALLY GUNG SHOW AND WORKING SO HARD AT, WE'RE NOT GOING TO BE ABLE TO COORDINATE ANYTHING IN THE MOST EFFECTIVE WAY. TESTING THOSE INTERVENTIONS IS PART OF IT BUT I'M DELIGHTED TO HEAR THAT YOU RECEPTIVE TO THE PART WHICH IS IT DOESN'T REALLY MATTER HOW GOOD THE TECHNOLOGY IS IF SOMEONE IS NOT WILLING TO TAKE ADVANTAGE OF IT OR IT'S PERCEIVED AS NOT DESIRABLE. HOW DO YOU LINK THAT TECHNOLOGY TO SOMETHING THAT IS ACCESSIBLE SEEN AS A POSITIVE, BECOMES VALUE-ADDED IN SOMEONE'S LIFE, IS NOT DISRUPTIVE AND INCOMPETENT GREATED WITINTEGRATEDBECAUSE T HE MOBILE PIECE I THINK, THAT'S ONE OF THE PIECES I'M SO EXCITED ABOUT AND OBVIOUSLY THE SMALLER THE BETTER AND THE FASTER THE BETTER. THE MOBILE PIECE I THINK HAS BEEN IMPLEMENTED IN SOME OTHER SITUATIONS IN A VERY EFFECTIVE MANNER. IT ALSO DEPENDS ON THE TEAM THAT IS, YOU KNOW, PERSONNING THAT MOBILE BAN, RIGHT. >> ABSOLUTELY. AND SO THIS IS PART OF THE PATCHWORK ORGANIZATION THAT WE'VE CREATED WITH ALL OF THE DIFFERENT ACADEMIC AND FOR PROFIT AND NOT FOR PROFIT ENTITIES WHERE THERE'S ENORMOUS REGULAR DISCUSSIONS AND MEETING AROUND ALL OF THESE PROBLEMS. NONE OF US INDIVIDUALLY ACTUALLY HAVE ANY OF THE ANSWERS AND I THINK THIS IS ONE INCREDIBLE SETTING WHERE PEOPLE ARE COMING TOGETHER TO DISCUSS THIS. WE ARE REALLY, THIS IS EXACTLY THE RIGHT MOMENT WHERE WE CAN NOW HAVE THIS DIALOGUE. I THINK A MONTH A. AGO, I WOULD HAVE BEEN DEEP IN TRYING TO PUSH OUT THE CONTRACTS FOR THESE WORK PACKAGES. DO DO ONE CONTRACT UNDER NORMAL NIH CIRCUMSTANCES CAN BE 15 MONTHS TO TWO YEARS WHERE WE HAVE 22 CONTRACTS. >> SO, CONGRATULATIONS ON THAT AND I HOPE THAT MEANS ALL OF OUR FUTURE CONTRACTS WILL BE DONE THAT FAST AND I DO WANT TO GIVE AS WE'RE AT OUR TIME, A MOMENT TO MAKE HER COMMENTS AND SHE IS ASKING ABOUT WHO IS RESPONSIBLE FOR THE TECHNOLOGIES TO THE PUBLIC AND THAT ONLY MIGHT THERE BE DIFFERENCES IN ACCEPTANCE BETWEEN THE SEXES AND GENDER PLAYING A ROLE TOO BUT BASED ON RACE AND ETHNICITY AND EDUCATION AND SEC SO BRUCE, DO YOU WANT TO REPLY TO THAT ONE? >> SURE. WELL, FUNDAMENTALLY THE TECHNOLOGIES ARE BEING DEVELOPED BY THE COMPANIES AND ACADEMIC GROUPS SO THE NUMBER OF PERFORM ARREST ARE SMALL COMPANIES. THEY'RE WORKING TOGETHER WITH REGULATORY ACADEMIC ENTITIES AND THE GOVERNMENT IN ORDER TO TRY TO FIND -- THEY ALL HAVE TO GO THROUGH AN ARGUMENT IN OUR PROCESS HOW THE TECHNOLOGY PERFORMANCE WILL MATCH THE COMMUNITIES. THE DIFFERENT COMMUNITIES THEY TARGET. SO EVERY ONE HAS BEHIND IT, THAT DESCRIPTION AND NOW THAT THAT IS BEING PUT TO THE TEST, WHERE THE NIH'S ROLE BECAUSE WE'RE LAUNCHING THESE FROM CONCEPT STAGE TO MANUFACTURING AND SCALE UP, IS A LITTLE BIT SORT OF NOW STEPPING BACK, WE DON'T WANT TO PROMOTE ONE TECHNOLOGY OVER ANOTHER. WE WANT TO DESCRIBE THE DIFFERENT FACETS AND ASPECTS OF THE TECHNOLOGIES SO THAT OUR PARTNERS CAN WORK TO UNDERSTAND THAT AND THEN MATCH THEM TO THE COMMUNITIES. SO, THIS IS A VERY DYNAMIC. YOU ARE SEEING THE PROCESS IN ACTION AND SO I DON'T HAVE A DEFINITIVE ANSWER OTHER THAN TO SAY EVERYONE HAD TO ARTICULATE THEIR TECHNOLOGY AND HOW THEY'LL GET IT AND WHY IT WILL IMPACTS THOSE GROUPS. >> THERE MIGHT BE AN IMPACT AROUND TECHNOLOGY AS A TOOL THAT NIH MIGHT BE ABLE TO PLAY IN TERMS OF TECHNOLOGY AND HEALTH, RIGHT. AND HEALTH LIT ARE SEE BUT WE APPRECIATE YOU AND TO COMMEND YOU FOR HEADING THIS UP. WE LOOK FORWARD TO FOLLOWING WITH YOU AND BRUCE, I HAVE SOME IDEAS FOR WAYS TONE GAGE THE COMMUNITY. I WOULD BE HAPPY TO REACH OUT TO YOU. >> WE ARE IN THE PROCESS OF DISCUSSING, AND IT'S BEEN MODERATED THROUGH OUR INTERACTIONS WITH THE ROCKER FELLER IN PARTICULAR, WAYS TO DO TEST STUDIES, USER COMMUNITY TEST STUDIES AND THIS IS THE RIGHT TIME. RADX UP IS MOVING ON THAT AND WE'RE ENGAGE WITH THAT BUT THERE WILL BE MORE OPPORTUNITIES FOR THIS AS WELL. >> THE LINK BETWEEN VACCINE AND TECHNOLOGY. IT'S A GREAT SEGWAY TO OUR NEXT SESSION. THANK YOU, BRUCE, REALLY DELIGHTED TO HAVE YOU JOIN US. AND IT'S MY PLEASURE TO INTRODUCE DR. HEALTH SCIENTIST ADMINISTRATOR AND PROGRAM OFFICER AT ORWH WILL INTRODUCE OUR NEXT SPEAKER. >> THANK YOU D DR. CLAYTON. IT'S MY PLEASURE TO TODAY'S PANELLEST. TODAY'S PANEL WILL BE MODERATED BY DR. MONICA WEBB HOOPER WITH PRESENTATION 0 DR. ALLISON McGREGOR, NEELSHAH AND DR. HOOPER HERSELF. OUR FIRST PRESENTER, DR. ALLISON McGREGOR IS A PHYSICIAN, WRITER AND EDUCATORS. SHE HAS BROUGHT THE CONCEPT OF SEX AND GENDER DIFFERENCES IN THE DELIVERY OF ACUTE MEDICAL CARE TO THE NATIONAL STAGE. SHE'S AN ASSOCIATE PROFESSOR OF EMERGENCY MEDICINE AT THE WARRENNAL BERT MEDICAL SCHOOL AND THE DIVISION OF SEX AND GENDER DEPARTMENT OF EMERGENCY MEDICINE. DR. McGREGOR IS ALSO CO-FOUNDER FOR THE NATIONAL ORGANIZATION SEX AND GENDER WOMEN'S HEALTH COP A COLLAB ARE TIVE COLLA BORATIVE. WELCOME DR. McGREGOR. >> THANK YOU SO MUCH. I REALLY AM HONORED TO CONTRIBUTE TO THIS MEETING. IT DID HITS HOME A LITTLE BIT WHEN WE HAD TO DO THE PHOTO VIRTUALLY. IT'S JUST, I MISS THAT OPPORTUNITY TO CATCH UP WITH EVERYBODY. I WILL SHARE MY SCREEN NOW. SO, WE'VE HEARD DIFFERENT ASPECTS ABOUT HOW SEX AND GENDER ARE INTEGRATED INTO THIS COVID-19 PANDEMIC. WHAT HAPPENED IS IT'S REALLY STRESSED THE HEALTH-CARE SYSTEM OUT, RIGHT. SO, WE'VE DISCOVERED WHAT REALLY WORKS WELL AND DISCOVERED FAULT LINES IN THIS MEDICAL SYSTEM SO WHAT I HOPE TO DO IS PROVIDE AN OVERVIEW OF YOU WILL ALL OF THE ASPECTS LOOKING AT THIS MAY ACTUALLY BENEFIT US AS MOST IS A VARIABLE AND GENDER HAS REALLY BEEN PROMOTED BY WOMEN ARE MORE LIKELY TO LOOK AT GENDER SPECIFIC ANALYSIS AND SEX AND SO IT'S REALLY HIGHLIGHTED THIS IS NOT JUST A WOMAN'S HEALTH PROBLEM. THAT THIS IS A PROBLEM FOR BOTH MEN AND WOMEN AND MEN AND WOMEN IN SOCIETY AND IT'S IN ITALY, THE ICU ARE MEN. THIS IS SOMETHING THAT'S BEEN ABLE TO TEACH US INTO A DIFFERENT DIRECTION AND SO THE WORLD HEALTH ORGANIZATION STARTED IN JANUARY TO START HAVING CASE REPORT OF THOSE WHO WERE SUSPECTED OF HAVING COVID-19. IF YOU LOOKED AT THIS DATA THE CASE BASED SURVEILLANCE IS ABOUT THE SAME FOR MEN AND WOMEN SO MEN AND WOMEN ARE GETTING INFECTED ABOUT THE SAME RATE. WHEN YOU LOOK AT GLOBAL HEALTH 5050, THIS IS AN INDEPENDENT EVIDENCE-GATHERING ORGANIZATION AND IT'S IN THE COLLEGE OF LONDON AND THEY HAVE A COVID-19 TRACKER WHICH IS FASCINATE TO GO SEE AND THEY ARE ABLE TO CONTACT THE GOVERNMENT WHEN IS REPORTED BY SEX OR FENDER AND THAT IS PART OF THE ISSUE AND THEY UPDATE THIS EVERY COUPLE WEEKS AND THIS WAS JUST UPDATE AID COUPLE DAYS AGO AND SO OUT OF THE COUNTRY THEY HAVE ACCESS TO, YOU CAN SEE THAT ONLY EIGHT COUNTRIES ARE PROVIDING SEX-BASED DATA ON TESTING. BUT WHEN YOU START GETTING INTO CONFIRMED CASES, HOSPITALIZATION AND ILLNESSES, THERE'S MUCH MORE DATA COMING OUT. SO, WE CAN ONLY LOOK AT THAT AS AVAILABLE AND HOPEFULLY TRY TO PROMOTE MORE PEOPLE FROM PRESENTING THEIR DATA BASED ON SEX. YOU CAN SEE HOSPITALIZATIONS ARE MORE LIKELY TO BE MAIL AND AND IT HAS THE GLOBAL BASED ON COUNTRIES AND HERE IS THE USA DATA AND YOU CAN SEE-THROUGH OUT THE AGE RANGE THAT MEN ARE DYING MORE. THIS BRINGS UP THE POINT IS WHY IS THIS HAPPENING, RIGHT. WE'RE ALL VERY FAMILIAR WITH THIS SPIKE PROTEIN ON THE SARS-CoV-2 VIRUS. IT ATTACHES TO THE ACE 2 RECEPTORS. THEY'RE IN THEIR NASAL FAR NIX AND LUNGS AND GASTRO IT JUST REALLY FITS INTO THAT RECEPTORS AND IT'S IN THE PROSTATE AND SO WE KNOW THAT HE IS STROGEN INFLUENCES THE VIRAL ENTRY OF HIV AND OTHER VIRUSES LIKE ADINO VIRUS SO WE'RE FOCUSING IT'S FOR MEN TO HAVE THAT HIGHER INFECT ACTIVITY RATES AND THIS IS ALSO SHOWN IN RELATION TO MALE PATTERN BALDNESS SO THE HIGHER THE TESTOSTERONE LEVEL IN MEN THE MORE LIKELY THEY ARE TO HAVE MALE PATTERN BALDNESS AND IN SPAIN, THEY LOOKED AT THEIR MEN THAT WERE HOSPITALIZED AND 71% OF THEM HAD MALE PATTERN BALDNESS. WHEN THE BACKGROUND RATE AND 30 TO 50. IT DEMONSTRATES THAT THERE IS A HIGHER RISK FOR MEN WITH HIGHER LEVELS OF TESTOSTERONE. THE CLINICAL MANIFESTATIONS OF THIS DISEASE IS HETEROGENEOUS. WE HAVE ASYMPTOMATIC INDIVIDUALS, WE HAVE THOSE WITH RECEIPT PA TIERESPIRATORY DISTRESS AND SO, THROUGH THAT SPECTRUM, THEY'RE STARTING TO LOOK AT SOME TRENDS AND THAT MEN ARE MORE LIKELY TO PRESENT WITH HARD SIGNS LIKE COUGH AND FEVER. AND WOMEN ARE MORE LIKELY TO PRESENT WITH HEADACHES, FATIGUE, AND FASCINATING BECAUSE WOMEN ARE KNOWN TO HAVE HIGHER SENSITIVITY TO SMELLS AND SO WE KNOW THAT ESTROGENS AS TARGETS OF THE FACTORY NERVES AS WELL SO THERE'S SOME CONNECTION THERE AND HOWEVER, I ALSO AM CONCERNED THAT A LOT OF THESE ARE OFTEN ARE NOT CONSIDERED TO BE VERY OBJECTIVE AND SO IT'S HARD TO MEASURE FOR WOMEN WHEN WE THINK ABOUT DRUGS IT'S IMPORTANT WE LOOK AT SEX-SPECIFIC DATA AND MOST OF THE TIME THESE ARE LACKING, FOR INSTANCE, WITH HYDROXYCHLOROQUINE. THIS IS A DRUG USED FOR MALARIA AND LUKE US AND OF COURSE IT GAINED A LOT OF MOTEL RYE TEE BECAUSE IT SHOWED BENEFITS AND SO, PEOPLE WERE TAKING IT. THIS PARTICULAR STUDY HAS ONE OF THE LARGEST ONES THAT IS OUT THERE AND THEY ACTUALLY SHOWED THAT THERE IS NO BENEFIT TO MORTALITY AND TURNING ZERO CONVERSION NEGATIVE TO SYMPTOMS BETWEEN MEN AND WOMEN. HOWEVER, IT DID INDICATE THAT WOMEN ARE MORE LIKELY TO HAVE RISK ASSOCIATED WITH THIS DRUG AND IT CAN LEAD TO FATAL A RIG MIA. WHEN YOU LOOK AT ANTI VIRALS, THIS IS NOT BEING REPORTED BASED ON SEX OR GENDER DATA. SO WE'RE MISSING AN OPPORTUNITY HERE TO SEE IF THIS IS ACTUALLY HAVING DIFFERENTIAL BENEFITS. SO FAR IT HASN'T SHOWN TO BE EFFECTIVE. THE ONLY THING THAT REALLY HAS SHOWN TO BE EFFECTIVE SO FAR IS THE STERILIZE. THE SAME STUDY GROUP IS LOOKING AT THIS. IT IS SHOWING A IMPROVEMENT IN MORTALITY BUT AND IT CAN LEAD TO FATAL A RIG MIA. WHEN YOU LOOK AT ANTI VIRALS, THEY HAVE MADE ANTIBODIES AGAINST THAT VIRUS SO WE COLLECTED THAT MASS MA AND THOSE IMMUNE CELLS AND WE INJECT THEM INTO OTHER PEOPLE AND TO HELP THEM WITH THEIR IMMUNE SYSTEMS, WHEN THEY MOST NEED IT. AND SO, THIS WAS A SMALL STUDY AND CHINA OF 331 INDIVIDUALS AND I FIND IT REALLY FASCINATING BECAUSE IT MIGHT ACTUALLY ILLUMINATE WHEN IS THE RIGHT TIME TO ACTUALLY GIVE THESE INFUSIONS AND SO THEY LOOKED AT MEN AND WOMEN WHO TESTED POSITIVE FOR COVID-19 AND YOU DEVELOP YOUR IGG ANTIBODIES AFTER A COUPLE WEEKS YOU CAN SEE THAT FEMALES MOUNT A HIGHER IGG RESPONSE AND THEY EVEN OUT. THEY LOOK AT SEVERITY OF SYMPTOMS. WHEN THE DISEASE IS MILD OR GENERAL, TO WHEN WE TARGET THOSE INFUSIONS. VACCINATION. THIS IS SOMETHING THAT WE ARE REALLY COUNTING ON AND SO, NORMALLY FOR A VACCINATION TO MAKE IT THROUGH, ALL OF THE APPROVAL YOU HAVE TO GO THROUGH LOTS OF FACES AND APPROVAL BY THE CDC AND FDA AND WE AND REALLY HAS AN IMPORTANT EFFECT BASED ON YOUR GENETICS AND BASED ON YOUR ENVIRONMENT AND BASED ON MICRO BIO AND THAT WAS ALSO MENTIONED AND BASED ON BIOLOGICAL SEX. DO WE KNOW THIS IS GOING RIGHT NOW. THERE'S A LOT OF WORK BEING DONE TO PROVIDE THIS AS EARLY AS POSSIBLE BUT LOOKING AT SOME OF THE INFORMATION THAT DR. KLEIN'S AND OTHER PEOPLE WHO WORK ON THIS HAVE REALIZED FROM OTHER INFECTIONS OR OTHER VIRAL INFECTIONS LIKE INFLUENZA AND WE KNOW THAT WOMEN MOUNT A HIGHER MAGNITUDE IMMUNE RESPONSE WHEN GIVEN THE VACCINE. TO MOUNT A HIGHER IMMUNE RESPONSE THAN MEN. WOMEN WILL HAVE LOWER MORTALITY RATES AND WOMEN HAVE MORE SEVERE ADVERSE EVENTS FROM THE VACCINATION. SO MORE LIKELY TO HAVE RASH AND FEVER AND ILL APPEARING SO IF WE'RE LOOKING AT WHAT WE'VE KNOWN IN THE PAST, WE'RE TRYING TO GET A VACCINE AS QUICKLY AS POSSIBLE AND ONE THAT IS SAFE AND EFFECTIVE AND THEN WE NEED TO IMMUNIZE THE ENTIRE GLOBE SO THAT IS GOING TO BE VERY CHALLENGING AND SO I THINK IT'S SO IMPORTANT THAT IF WE UNDERSTOOD THE ABILITY TO DECIDE WHAT DOSE OF VACCINES AND MAYBE THEY DON'T NEED A BLISTER OR THEY NEED A SHORTER COURSE WE MIGHT HAVE A PUBLIC-HEALTH STANDPOINT VACCINATE MORE PEOPLE AT ONES. NOW, WITH TREATMENTS THAT ARE ON GOING AND HOSPITALS, THERE'S PRONE POSITIONING. SO, NORMALLY, WHEN YOU ARING SITTING LAYING ON YOUR BACK AND IF YOU HAVE LOTS OF ADEMA AND PNEUMONIA AND INFLAMMATORY FLUID IN YOUR LUNGS IT SETTLES TO THE PARTS OF THE LUNGS. AND SO, THIS IS OFTEN REFERRED TO AS ACUTE RESPIRATORY DISTRESS SYNDROME. THIS IS WHERE WE'VE LEARNED THAT WHEN YOU FLIP THE PATIENT ON TO THEIR STOMACH AND IT HAS PER SURFACE FOR WE'RE USING THAT KNOWLEDGE BASE AND NOW, IF YOU LOOK AT THE SEX BASED DIFFERENCES WOMEN ARE MORE LIKELY TO UNDERGO ACUTE FROM A CRITICAL INJURY. WOMEN ARE LESS LIKELY TO BE ON PROTECTIVE VENTILATION REGULATIONS AND I'M TRYING TO THINK OF THE REGULATIONS SO THE VENTILATOR SETTINGS, THANK YOU. SO, WOMEN HAVE DIFFERENT TITLE VOLUMES BECAUSE OF THE BODY FAT PERCENTAGES AND THESE SOURCE OF THINGS THAT REALLY COULD BE INCLUDED INTO OUR SEX-SPECIFIC UNDERSTANDING OF THIS AND WHEN I LOOKED BACK TO SEE HOW WE REALLY CAME TO UNDERSTAND THIS, A LOT OF THIS UNSURPRISINGLY IS BASED ON MEASUREMENTS OF MEN AND SO, IF WE LOOK, WOMEN, ARE ALSO REQUIRING THIS PRONE POSITIONING AND WOMEN HAVE DIFFERENT FACIAL STRUCTURES AND JAW AND WE HAVE DIFFERENT PELVIC GRILL AND DIFFERENT BODY FAT DISTRIBUTIONS AND BREAST AREA THAT ARE REALLY NOT BEING TAKEN INTO ACCOUNT AND THIS IS A PHOTO OF BREAST TISSUE FROM A PHONE POSITIONING. WHAT ABOUT PREGNANCY? WOMEN WHO ARE PREGNANT OF COURSE ARE HARDLY EVER IN CLINICAL TRIALS AND SO PREGNANT WOMEN WHEN THEY ARE PRONE, BENEFIT GREATLY BECAUSE THE UTERUS IS VERY HEAVY AND IT CAN COMPRESS THE A OR TA AND IT MAY BE HE CAN EFFECTIVE. SOMETHING AS SIMPLE AS A DESIGN THAT TAKES INTO ACCOUNT THE DIFFERENT PHYSIOLOGY BETWEEN MEN AND WOMEN. I THINK CAN DO AMAZING BENEFITS. WE ALSO HAVE SOCIAL CULTURAL BEHAVIOR THAT'S DIFFERENT. SO MEN ARE LESS LIKELY TO PRESENT WITH SYMPTOMS WHEN ILL, WE SAW THAT WITH EBOLA. MEN WERE LESS 12 HOURS LATER MORE LIKELY TO PRESENT WITH SYMPTOMS SO THAT HIGHER MORTALITY RATES WITH EBOLA. MEN HAVE MORE SMOKING HABITS. LESS NUTRITION AND WOMEN ARE DEALING WITH THESE PSYCHIATRIC STRESS OF THE HOME LIFE. THESE STEREO TYPES ARE STILL IN EXISTENCE. WHEN WE LOOK AT HANDWASHING, WE KNOW THIS IS VERY EFFECTIVE AND SO IT'S TRAVELING TO ME TO REALLY UNDERSTAND HOW SUCH DIFFERENCES BETWEEN MEN AND WOMEN'S BEHAVIOR OF HANDWASHING CAN ACTUALLY BE SIGNIFICANT AND SO IN THE STUDYING OF WATCHING MEN LEAVE PUBLIC RESTROOMS AND WOMEN LEAVE PUBLIC RESTROOMS, 7% OF WOMEN ARE NOT GOING TO WASH THEIR HANDS BUT UPWARDS OF 70% OF MEN DO NOT WASH THEIR HANDS WHEN THEY LEAVE A PUBLIC REST ROOM. 35% USE SOAP COMPARED TO WOMEN. THIS SHOWN IN CRITICAL CARE. WOMEN ARE MORE LIKELY TO WASH THEIR HANDS THAN MEN. SO WHEN YOU THINK ABOUT T. NOT ONLY ARE WASHING HANDS SO IMPORTANT, BUT IF WE LOOK AT HOW WE'RE WASHING OUR HANDS, I HAVE COMPLETELY CHANGED THE WAY I USE PURELL AND WASH MY HANDS AT WORK. IF SOME OF YOU ARE SURGEONS, YOU'VE ALREADY REALLY HAD THE UNDERSTANDING OF THIS. SO, SAME THING WITH FACE MASKS. MEN ARE LESS LIKELY TO WEAR FACE MASKS BECAUSE OF THIS CONCEPT OF MASCULINE IDEOLOGY THAT MASKS ARE NOT MASCULINE ENOUGH AND SO, THAT HAS REALLY BEEN AN UNFORTUNATE CONCEPT BECAUSE WHO ARE THE SUPER SPREADERS? IF MEN ARE LESS LIKELY TO WASH THEIR HANDS, LESS LIKELY TO WEAR A MASK, MORE LIKELY TO HAVE SEVERE DISEASE, ALL IT TAKES IS ONE SNEEZE OR A COUGH AND TRILLIONS OF VIRUSES ARE PLACED INTO THE AIR. SAME THING WITH PPE, RIGHT, WE LEARNED THIS. THAT P.P.E. DOES NOT FIT WOMEN AS MUCH AS MEN. AND SO, WHEN GO TO THE CDC WEBSITE, YOU ARE SEEING IMAGES OF P.P.E. FITTING MEN AND SO THIS IS NOT THE KIND OF MESSAGES THAT WE NEED. HOW MANY PHOTOS OF MALE FACIAL HAIR DO WE NEED TO UNDERSTAND THAT HOW THEY FIT DIFFERENTLY? WOMEN HAVE DIFFERENT FACIAL STRUCTURES. ASIAN POPULATIONS HAVE DIFFERENT FACIAL STRUCTURES. WOMEN ARE MORE LIKELY TO UNDERGO PSYCHOLOGICAL STRESS AT HOME. HIGHER INTIMATE PARTNER VIOLENCE BECAUSE OF THE STATE AT HOME ORDERS AND THE LONG-HAULERS. SO THIS IS ALSO BEEN MENTIONED. MY GREATEST CONCERN IS THIS COMING UP AND FOR WOMEN BECAUSE, IF THE INFLUENZA 90% OF THOSE WHO HAVE INFLUENZA ARE SYMPTOM-FREE, WITHIN TWO WEEKS, WE HAVE USED HA AND OUR HOPING THAT THAT'S THE CASE FOR COVID-19 BUT THE CDC SAYS ONE-THIRD OF NON HOSPITALIZED PATIENTS ARE STILL SYMPTOMATIC AFTER TWO WEEKS, THESE ARE MORE LIKELY TO BE WOMEN, THEY'RE MORE LIKELY TO HAVE FATIGUE, WE KNOW THAT VIRAL SYNDROMES CAN CAUSE PROBLEMS AND LOTS OF CHRONIC FATIGUE SYNDROME. THIS IS SOMETHING THAT IS VERY SIGNIFICANT. IF HISTORY REPEATS ITSELF, I'M GETTING A DINOSAUR. I STARTED SHOPPING FOR MY DINOSAUR AND CALLING IT ROSEMARY JUST BECAUSE. THIS IS A PRE PRINT. THIS IS NOT UNDERGOING PEER REVIEW AND IT DOES SHOW THAT OF THE TRIALS THAT ARE REGISTERED, AND CLINICAL TRIALS.GOV, 16% MENTIONED SEX AND GENDER AND 4% SAY THEY MAY DO ANALYSIS. THEY ALLUDE TO IT. SO WE NEED THE RIGHT EVIDENCE AT THE RIGHT TIME TO REALLY MAKE SURE THAT WE ARE INTEGRATING THIS THROUGHOUT OUR KNOWLEDGE BASE SO THAT WE CAN HAVE APPROPRIATE PUBLIC-HEALTH MEASURES BOTH LOCALLY, REGIONALLY AND NATIONALLY. THANK YOU. >> OUR NEXT PANELIST IS DR. SHAH. HOLD ON ONE MOMENT, PLEASE. OUR NEXT PANELIST IS DR. NEEL SHAH AND FROM HARRARD MEDICAL SCHOOL AND THE DIRECTOR OF DELIVERY DECISIONS INITIATIVE AT ARIADNE LABS. DR. SHAH CARES FOR PATIENT AT CRITICAL LIFE MOMENT THAT'S RANGE FROM CHILDBIRTH TO PRIMARY CARE TO SURGERY. AS A SCIENTIST AND SOCIAL ENTREPRENEURS HE IS A GLOBALLY RECOGNIZED EXPERT IN DESIGNING, TESTING AND SPREADING SOLUTIONS THAT IMPROVE HEALTHCARE. PRIOR TO JOINING THE HARVARD FACULTY THE COSTS OF CARE, A GLOBAL NGO THAT CURE IT'S A INSIGHTS FROM CLINICIANS, TO HELP THE DELIVERY SYSTEM PROVIDE BETTER CARE. IN 2017, DR. SHAW CO FOUNDED THE MARCH FOR MOM ASSOCIATION I COALITION OF 40 LEADING ORGANIZATIONS TO INCREASE PUBLIC AND PRIVATE INVESTMENT AND THE WELL-BEING OF MOTHERS. WELCOME DR. SHAH. >> THANK YOU SO MUCH FOR THE OPPORTUNITY TO SHARE THOUGHTS AND THANK YOU TO MICHAEL FOR HELPING ME WITH NAVIGATING MY SLIDES. I REALLY WANTED TO FRAME WHAT I HAD TO SAY AROUND DR. McGREGOR'S COMMENTS, WHICH ARE REALLY A TOUR TO FORCE OF UNDERSTANDING THE BIOLOGY AND THE SO HE IS OLE GOUGH OF COVID-19 AND HOW IT'S EFFECTING PEOPLE AND JUST REALLY WANT TO LAYER ON TO THAT REALLY JUST A FEW THOUGHTS REALLY AND FOCUSED ON CHILDBIRTH AND I THINK ABOUT SYSTEMS AND I'M CONSCIOUS OF THE FACT THAT THE OF THE WAYS WE'RE TRYING TO PROVIDE CARE RIGHT NOW, ARE KIND OF INSPITE OF A NUMBER OF BARRIERS AND DISRUPTIONS THE WAY THAT WE USED TO PROVIDE CARE. SO WE CAN GO AHEAD TO GO TO THE NEXT SLIDE. THERE ARE TWO QUESTIONS THAT I THINK HAVE AN ON A LOT OF PEOPLE'S MIND. PARTICULARLY EARLY IN THE VIRUS BUT ON GOING THERE'S BEEN A LOT OF CONCERNS ABOUT WHETHER OR NOT PREGNANT PEOPLE ARE MORE LIKELY TO BE SEVERELY INFECTED BY COVID-19 AND MY INTERPRETATION OF THE EVIDENCE AS A FORWARD LED CLINICIAN IS IT'S STILL UNCLEAR AND I WILL TRY TO TELL YOU WHY THAT IS. I THINK REGARDLESS OF WHETHER OR THEY'RE CLEARLY MORE LIKELY TO BE SEVERELY AFFECTED. I THINK THE ANSWER TO THIS QUESTION IS UNCLEAR. AND WHEN WE THINK ABOUT PEOPLE WHO ARE PREGNANT, THERE'S A CONCERN ABOUT THE PERSON HERSELF WHO IS PREGNANT POTENTIAL I AM ACT ON THE PLACENTA AND THE FETUS AND IMPACT ON A NEWBORN BABY. SO IF GO TO THE NEXT SLIDE, YOU KNOW, TO MY READ OF THE EVIDENCE, THANKFULLY IT DOES NOT APPEAR RIT NOW THAT SEVERE INFECTION FOR PREGNANT PEOPLE IS DIFFERENT FOR PEOPLE WHO ARE NOT PREGNANT OR DIFFERENT FROM PEOPLE WHO ARE NOT PREGNANT. THEY TEND TO BE MORE SEVERE IN PREGNANT PEOPLE AND IT'S NOT THE CASE HERE AND ALTHOUGH PLAUSIBLE FOR IN CONCLUDING THE IMPACTS OF COVID-19 ON ALL OF THE ORGAN SYSTEMS THAT HAVE BEEN MENTIONED EARLIER TODAY. WE ARE SEEING THAT PREGNANT PEOPLE ARE HOSPITALIZED AND I SHOULD POINT OUT THIS DATA STARTED OFF IN MARCH AND APRIL FOR THOSE OF US WHO ARE CLINICIANS, READING CASE REPORTS AND I PERSONALLY HAVE BEEN, NEVER BEEN SO DEPENDENT ON CASE REPORTS TO MAKE LIFE AND DEATH DECISIONS. IT WASN'T UNTIL LATE INTO THE SPRING WE SAW SOME CASE SERIES AND SOME COHORTS STUDIES AND NOW THERE ARE A NUMBER OF VERY LARGE COHORT STUDIES THAT ARE TRYING TO ANSWER THESE QUESTIONS AND I THINK WE'LL TAKE STILL, A FAIR AMOUNT OF TIME TO BEAR CONCLUSIVE RESULTS. BUT WE DO SEE THAT PREGNANT PEOPLE ARE HOSPITALIZED FOR CDC DATA BUT IT'S WRAPPED UP IN A NUMBER OF POTENTIAL CONFOUNDING INFORMATION INCLUDING PREGNANT PEOPLE GET HOSPITALIZED COMPARED TO NON PREGNANT PEOPLE TO HAVE THEIR BABIES AND THAT WASN'T CLEARLY TEASED OUT. WE MAY ALSO HAVE DIFFERENT THRESHOLDS FOR HOSPITALIZING AND CARRYING FOR PEOPLE WHO ARE PREGNANT. THERE ARE SOME EMERGING EVIDENCE AS WELL THAT THERE'S BEEN A LOT WRITTEN ABOUT LONG-HAULERS THAT PEOPLE HAVE WHO CHRONIC SYSTEMS AND IT MIGHT BE IN PREGNANT PEOPLE AS WELL AND WITH REGARD TO THE PLACENTA, ALL DAY WE'VE TALKED ABOUT THE PLACENTA AND SO AGAIN, IT'S BIOLOGICALLY PLAUSIBLE IT COULD BE WRAPPED UP IN ALL OF THIS AND THERE IS SOME EVIDENCE THIS COULD OCCUR BUT IT SEEMS TO BE RARE. VERTICAL TRANSMISSION IS POSSIBLE AND BASED ON DAY ONE TESTING AND VERY RARE. AND WE ARE SEEING ON TREND INCREASE THIS IS THE STILLBIRTH AND PREMATURE TEE WHICH IF IT IS BIOLOGICALLY LINKED TO COVID-19 COULD BE THROUGH THE IMPACT OBJECT THE PLACENTA BUT IT'S UNCLEAR THE MECHANISM AND WHETHER OR NOT THIS IS A TRUE TREND RELATED TOWN FEX ITSELF AND WITH REGARD TO THE BABY, MATERNAL INFANT TRANSMISSION VIA RESPIRATORY PATHWAY SEEMS POSSIBLE AND SEEMS TO BE RARE WITH PRO CAUTION AND IT HAS IMPLICATIONS FOR BREASTFEEDING AND ALL THE OTHER THINGS THAT MOMS NEED TO DO TO TAKE CARE OF THEIR BABIES. THERE WERE SEVERE INFECTION THAT WAS RARE AND TRANSMISSION OF BREAST MILK SUN LIKELY AT THIS POINT AND SO IN SOME, A LOT OF THIS IS REASSURING WITH THE CAVEATS THAT YOUNG AND HEALTHY PEOPLE CAN BE SEVERELY INFECTED TOO AND THIS IS SAYING THAT IT DOESN'T CONFER A DISPROPORTIONATE RISK SO LET'S GO TO THE NEXT SLIDE. ER PREGNANT PEOPLE MORE SEVERELY AFFECTED BY COVID-19. DEFINITELY. I WANT TO QUALIFY THIS. GO TO THE NEXT SLIDE. THIS IS IS TIMELY HEALTH SERVICES DATA BASED ON WHAT I CALL PUBLIC REPORTING BECAUSE I THINK WE'RE REALLY ON THE FUZZY EDGES OF DATA RIGHT NOW AND THE DISTINCTION WHAT I WOULD HAVE CALLED AN ANECDOTE AND DATA IS LESS CLEAR. ONE THING THAT IS TRUE ACROSS THE COUNTRY IS THAT WE HAVE HAD A 90-YEAR-OLD MODEL OF DELIVERING PRE NALLAL CARE THAT HAS BEEN RINGETTE AND NOT BASED ON A LOT OF EVIDENCE AND DECIDED BEEN DISRUPTIVE SO EARLY IN THE PANDEMIC, A LOT OF PRENATAL CARE WAS SUSPENDED ACTUALLY AND IT RESULTED IN LESS VISITS AND DIFFERENT DISRUPTED AND LOWER QUALITY VISITS AND ON TREND, ON REPORT WE'RE HEARING MORE ABOUT PARTNER VIOLENCE AND WE'RE HEARING ABOUT INCREASED SOCIAL ISOLATION AND IT WAS ALREADY A CHALLENGE FOR A LOT OF PREGNANT PEOPLE AND DURING LABOR AND DELIVERY WE'VE GOT INAMOUNTS OF INFORMATION ABOUT PEOPLE HAVING LESS AGENCY AS A RESULT OF THE PROTOCOLS INCLUDING EVERYTHING FROM NEEDING TO BE MASKED AND TO HAVING LESS AVAILABLE LABOR SUPPORT AMID VISITOR RESTRICTIONS. AND A LOT OF HOSPITALS AS THEY TRIED TO DEAL WITH CAPACITY ISSUES HAVE BEEN DISCHARGING PREGNANT PEOPLE AFTER THEY HAVE HAD THEIR BABIES MUCH MORE QUICKLY WITHOUT MAKING SURE THEY HAVE THE EDUCATION AND OTHER SUPPORT THEY NEED TO TRANSITION HOME. POSTPARTUM IS WHEN PEOPLE ARE TRYING ATTORNEY A LIVING WAGE AND TAKE CARE OF INFANTS GETTING LITTLE SLEEP AND ALL OF THAT IS DURING A TIME OF ECONOMIC RECESSION AND TENS OF MILLIONS OF AMERICANS LOSING THAN JURORS TO PUBLIC SYSTEMS SO, THIS IS COMPOUNDED BY THE FINANCIAL STRAIN AND AGAIN, HAVING TO DO THIS IN AN ISOLATED WAY AND ONE CAN IMAGINE IT HAS AN IMPACT ON MENTAL HEALTH OF COURSE AS WELL SO IT'S SOMETHING THAT WE'RE AIMING TO BE VIGILANT ABOUT AND HAS LIMITED CAPACITY. SO LET'S GO TO THE NEXT SLIDE. I WANT TO POINT OUT ALSO THE AGREE TO WHICH COVID-19 HAS REVEALED THE WAYS THAT BIOLOGY AND SOCIOLOGY INTERACT AND I THINK DR. McGREGOR DID AN INCREDIBLE JOB OF SPAN THE THE BREADTH OF CONSIDERATION IN HER TALK. WHY WANT TO BELABOR IT. PREGNANT PEOPLE ARE A BELLWETHER FOR THE PEOPLE OF ALL OF US AND SENSITIVE TO EVERY I OBJECT JUSTICE WE HAVE IN OUR SOCIETY AND HUMANITARIAN DISASTERS LIKE THOSE WE'RE DEALING WITH NOW WHETHER IT'S A WAR OR WEATHER EVENT SEEM TO EFFECT PREGNANT PEOPLE DISPROPORTIONATELY AND WE KNOW A BASELINE IN OUR COUNTRY, IF YOU ARE BLACK YOU ARE THREE TO FOUR TIMES MORE LIKELY TO DEATH AND I ALSO KNOW IN CERTAIN PARTS OF OUR COUNTRY, THOSE DISPARITIES WHICH ARE ALREADY HORRIBLY WIDE OR WIDER SO IN NEW YORK CITY, IF YOU ARE BLACK YOU ARE EIGHT TO 12 TIMES MORE LIKELY TO TIE BECAUSE OF THE WAY THAT MANY CITIES AND PLACEs IN OUR COUNTRY ARE RACIALLY SEGREGATED IN TERMS OF PLACE AND OPPORTUNITIES THAT PEOPLE HAVE TO THRIVE AND TO BE WELL AND SO WE CERTAINLY SAW THIS WITH REGARD TO PREGNANT PEOPLE AND AGAIN BY ANECDOTE THERE'S HEARTBREAKING STORIES OF PEOPLE WHO EXPERIENCED A LOT OF THE HARDSHIP THAT CAME WITH THE PANDEMIC AND WAYS IN WHICH IT COMPOUNDED STRUCTURAL AND SYSTEMIC RACISM. SO GO AHEAD AND GO TO THE NEXT SLIDE. WITH THE PANDEMIC HAS DONE IS DIVIDED THE WORLD TO PEOPLE WHO CAN PROTECT THEM AND IT'S TRUE ACROSS AND SO IT'S EQUALLY TRUE TO ACROSS NEIGHBORHOOD BLOCKS AND WEEK SEEING IT'S NOT JUST PREGNANT PEOPLE ARE IMPACTED BUT SOME PEOPLE ARE MORE LIKELY TO BE MORE SEVERELY IMPACTED THAN OTHERS AND THAT A SHARE OF LATINX COMMUNITY AND NATIVE COMMUNITY AND BLACK COMMUNITY IN SEVERE CASES AMONG PREGNANT PEOPLE AND THE GENERAL POPULATION AND TRUTHFULLY WE DON'T HAVE AS ROBUST DATA AS WE NEED TO REALLY UNDERSTAND THESE PROBLEMS AND MAKE SURE WE ATTEND TO THEM. SO, WE'LL GO TO NEXT SLIDE. END THIS ON A POSITIVE NOTE, WHAT I HAVE TO SAY IS THAT WHILE WE'RE DOING TO UNDERSTAND THE BIOLOGICAL IMPACTS OF COVID-19, WE SHOULD ALSO ATTEND TO THE FACT THAT A PANDEMIC HAS TAKEN EVERIEN EQUITY AND THROWN IT INTO A PRESSURE COOKER AND IT'S NOT ONLY THAT RACISM SHOWS UP IN MATERNAL HEALTH, MA TRACTOR-TRAILER ARE NOT HEALTH IS ONE OF THE LEADING CATERS THAT RACISM IS A CLEAR AND PRESENT DANGER IN OUR SOCIETY AND IT'S TRUE OF EVERY INJUSTICE AND SEEN A PHOBIA AND GENDER AND EQUITY AND SO THAT'S TERRIBLE AND ALSO PROVIDES AN OPPORTUNITY TO LOOK AT THE WAYS THESE PROBLEMS HAVE BEEN STARK RELIEF AND MAKE CHANGES AND WE'RE SEEING MOMENTUM TOWARDS LARGE AND JUST BEFORE THE PANDEMIC HIT JANUARY THE NATIONAL ACADEMY OF MEDICINE ISSUED A REPORT TALKING ABOUT THE NEED TO PRO TIGHT BIRTHING PEOPLE AND SAFETY OF OPTIONS FOR PEOPLE TO GIVE BIRTH AND I THINK THE PANDEMIC HASSEN ABILITY EXPANDED SETTINGS AND MORE ACCESS TO MIDWIVES AND DO AND PEOPLE HAVE LOOKED AT EQUITIESES AND WE'VE SEEN MUCH MORE USE OF TELEHEALTH AND VIRTUAL AND WHICH HAVE GREAT EVIDENCE AND FOR PREGNANT PEOPLE AND IT HIGHLIGHTS TO THINK CAREFULLY ABOUT AND INVESTMENTS IN BUILDING TRUST PARTICULARLY MARGINALIZED OPPRESSED COMMUNITIES WE FAILED TO SECURE AND THEY'RE SEEN DURING THE PANDEMIC AND THIS IS EFFECTED SO THANK YOU, VERY MUCH. THAT'S WHAT I HAVE TO SAY. >> DRU, DR. SHAW. OUR FINAL PRESENTER WELCOME BACK DR. HOOPER. THE DEPUTY DIRECTOR OF THE NIMHD AND SHE OVERSEES THE INSTITUTE AND SCIENCE VISIONING RECOMMENDATIONS TO IMPROVE HEALTH AND PROMOTE HEALTH EQUITY BEFORE NINING SHE WAS A PROFESSOR OF ONCOLOGY, FAMILY MEDICINE AND COMMUNITY HEALTH AND PSYCHOLOGICAL SCIENCES AT CASE WESTERN RESERVE UNIVERSITY. SHE WAS ALSO ASSOCIATE DIRECTOR FOR CANCER DISPARITIES RESEARCH AND THE DIRECTOR OF THE OFFICE OF CANCER RESEARCH IN THE CASE CENTER. SHE'S AN INTERNATIONALLY RECOGNIZED TRANSLATIONAL BEHAVIORAL SCIENTIST AND CLINICAL HEALTH SIGHTOLOGISTS AND DEDICATE HER CAREER TO THE SCIENTIFIC STUDY OF MINORITY HEALTH AND RACIAL AND ETHNIC DISPARITIES FOCUSING ON CHRONIC ILLNESS PREVENTION AND HEALTH BEHAVIOR CHANGE. SHE FOCUSES ON UNDERSTANDING PULLED' LEVEL FACTOR ANSUCH AS TOBACCO USE , STRESS PROCESSES AND THE DEVELOPMENT OF CULTURALLY SPECIFIC INTERVENTION AND TO CONTRIBUTE TO THE BODY OF SCIENTIFIC KNOWLEDGE AND DISSEMINATE FINDINGS INTO THE COMMUNITY WITH THE HIGHEST NEED. DR. HOOPER. >> THANK YOU, THANK YOU VERY MUCH FOR THAT REALLY BEHIND INTRODUCTION. I APPRECIATE THAT. I'M THE FINAL PRESENTER BEFORE WE MOVE INTO THE Q&A SESSION AND YOU CAN SEE THE TITLE OF MY PRESENTATION. I'LL TALK ABOUT NIH AND ALSO INTERSECTION REQUESTS UNDERSERVED POPULATIONS. SO I'LL START WITH A LITTLE. OUR MISSION IS TO LEAD SCIENTIFIC RESEARCH TO IMPROVE MINORITY HEALTH AND REDUCE HEALTH DISPARITIES AND WE ENVISION AN AMERICA IN WHICH ALL POPULATIONS WILL LIVE LONG HEALTHY AND PRODUCTIVE LIVES AND TO POLITICIAN THIS, WE RAISE NATIONAL AWARENESS ABOUT THE PREVALENT AND IMPACT OF HEALTH DISPARITIES AND EFFECTIVE, INDIVIDUAL COMMUNITY AND POPULATION LEVEL INTERVENTIONS THAT WILL LEAD US HOPEFULLY CLOSER TO HEALTH EQUITY. SO WHEN WE SAY HEALTH EQUITY, WE ARE REFERRING TO THE GOAL OF THE HIGHEST LEVEL OF HEALTH FOR ALL PEOPLE. TO ACHIEVE HEALTH EQUITY REQUIRES WE CLOSE THE GAPS WHICH OUR HEALTHCARE DISPARITIES THAT WE VALUE EVERYONE HE CANNILY AND WE ADDRESS AVOIDABLE HE INI CAN WET TEE AND PROVIDE SUPPORT THAT ARE PROPORTIONAL TO THE NEEDS AND WE MOVE BARRIERS TO OPTIMAL HEALTH. SO WHY IS IT TORT ANT FOR UNDERSERVED WOMEN IN PARTICULAR? THERE ARE MEDICAL ADVANCE THAT'S PREVENTED AND CURED DISEASE AND HELPED CHARGE BEHAVIOR AND EXTENDED LONGEVITY BUT NOT ALL POPULATION HAVE BENEFITED FROM THESE ADVANCEMENTS EQUITABLY. IT'S UNDERSTANDING WHAT HELD BIS TAR TEASE ARE AND LOOKING AT THE FACTORS ANDER SELECTIONS THAT -- THAT'S WH Y IT'S IMPORTANT TO STUDY HEALTH DISPARITIES AND THE HEALTH OF UNDERSERVED WOMEN. WE ARE IN THE MIDST OF TWO PANDEMIC. LONGSTANDING HEALTH DISPARITIES WITH A PANDEMIC IN THEIR OWN RIGHT AND THE COVID-19 PANDEMIC WITH A NEW WAVE OF DISPARITIES AND ADVANCED. HEALTH DISPARITIES LONG STANDING AND NEW ARE RELATED TO AND WE CAN GO AS FAR AS ARE ATTRIBUTABLE TO SOCIAL DETERMINANTS OF HEALTH AND THEY ARE CONTINUES IN THE ENVIRONMENT WHICH PEOPLE ARE BORN AND LIVE AND LEARN AND WORK AND WORSHIP AND AGE THAT EFFECT A WIDE RANGE OF HEALTH FUNCTIONS AND QUALITY OF LIFE OUTCOMES AND RISKS AND YOU CAN SEE EXAMPLES OF SOCIAL DETERMINANTS THAT I OBJECT CLOUD RESOURCES SUCH AS HEALTHY FOODS, OPPORTUNITIES FOR HIGH-QUALITY EDUCATION AND EMPLOYMENT, ACCESS TO QUALITY HEALTHCARE. PUBLIC SAFETY, SAFE AND AFFORDABLE AND THINGS LIKE DISCRIMINATION AND DISTRUST OF GOVERNANCE AND BICYCLE LANES AND ROADS AND OF COURSE ENVIRONMENT THAT'S ARE FRO OF LIFE-THREATENING TOXINS AND TER COMBINED TO INFLUENCE HEALTH OUTCOMES AND ADVANCE. ONE OF THE HEALTH OUTCOMES IS LIFE EXPECTANCY THIS IS A GOOD EXAMPLE OF WHY IT IS IMPORTANT TO EXAMINE SEX AS A BIOLOGICAL VARIABLE AND GENDER AS A SOCIAL VARIABLE SO AFRICAN AMERICAN HAVE A LOWER LIFE EXPECTANCY COMPARED TO WHITE AND LATINO CORPORATION AND LATINOS HAVE A LONGER LIFE EXPECTANCY COMPARED TO WHITE. AFRICAN AMERICAN FEMALES LIVE FEWER YEARS ON AVERAGE, COMPARED TO THEIR WHITE AND LATINO COUNTERPARTS. THE DATA INDICATES AFRICAN AMERICAN WOMEN HAVE POOR HEALTH COMPARED TO WHITE WOMEN AND BREAST CANCER AND AIDS AND MATERNAL MORBIDITY AND THE THE LARGELY TREATED AS A GROUP AND THE FACTOR THAT INFLUENCE HEALTH ARE APPLICABLE AND EFFECTIVE FOR ALL WOMEN. IT'S DEPENDER AND MAY MASK THE RISK AND UNIQUE EXPERIENCES OF VARIOUS WOMEN BASED ON OTHER SOUTHERLY CATEGORIES IF WE APPLY A HEALTH EQUITY LENS THE SCIENCE WOULD MOVE ON IMPROVING BLACK WOMEN'S HEALTH AND STUDY FACT AOR THAT PREVENT OTHER RACIAL WOMEN FROM THESE AND OTHER HEALTH DISPARITIES. WHEN WE LOOK AT SOCIOECONOMIC FACTORS, THERE'S A STRONG NEGATIVE GRADIENT IN THE RINK OF ALL CAUSE MORTALITY IN THE UNITED STATES. THESE DATA WERE FROM 2016 AND THEY SHOW THE RISK OF DEATH IS THREE TIMES GREATER AMONG INDIVIDUALS WHOSE HOUSEHOLD INCOME IS LESS THAN $25,000 PER YEAR. SO INCOME IS RELATED TO LIFE AND DEATH. AND THE RELATIVE RISK OF DEATH IS INCREASED AMONG AVENUE AMERICANS WOMEN AND WHO HAVE LOWER MEAN INCOME COMPARED TO WHITE AND ASIAN WOMEN MANY OF THE INCOME AMONG LATINO WOMEN IN 2019 WAS THE LOWEST OF THESE GROUPS YOU SEE HERE AND DESPITE THE DISADVANTAGES, AND HIGHER BURDEN OF SOME DISEASES, MORTALITY IS LOWER IN THE POPULATION. THIS IS A PHENOMENON DESCRIBED 30 YEARS AGO AS HISPANIC MORTALITY PARADOX ATTRIBUTED TO A HEALTHY MIGRANT EFFECTOR THE RELATIVELY LOW MEDICINE YAN AGE OF LATINOS RESIDING IN THE UNITED STATES. I NOTE LATINOS ARE A GROWING DEMOGRAPHIC GROUP THAT ENDURES AT VERSE SOCIAL AND HEALTH CONSEQUENCES AND LACK OF ACCESS TO HEALTHCARE. WE DON'T KNOW THE FULL EXPECT OF THE NOVEL CORONAVIRUS. WE KNOW THAT CASES IN THE UNITED STATES EXCEED 8 MILLION AND DEATHS 218,000 PEOPLE MANY OF THERE'S EVIDENCE OF COVID-19 IMPACTS ON SPECIFIC COMMUNITIES INCLUDING RACIAL AND ETHNIC MINORITIES. HERE IS A MODEL TO HELP ME THINK ABOUT FACTORS THAT CONTRIBUTE TO COVID-19 CASE AND OUTCOMES AND IT'S THE OVER ARCHING AND THIS MODEL IS EVOLVING AS MORE DATA IS AVAILABLE THEY ASK BE PUT INTO BUCKETS SOCIOECONOMICS YOU SEE HERE AND ALSO HEALTH AND WE CONDITION IGNORE THE BACK DROP OF SYSTEMICKEN EQUITY WHICH ARE ASSOCIATED WITH POOR HEALTH OUTCOMES. MUCH AS BEEN REPORTED ABOUT RACIAL ETHNIC MINUTE OR TEASE BEING IN JOBS THAT FORCED EXPOSURE TO THE VIRUS. TO GIVE ONE EXAMPLE AMONG NURSES WHO ARE MOSTLY WOMEN, KINDER MORGAN SURPRISE JUST 4% OF THE U.S. WORKFORCE AND NURSING BUT A THIRD OF NURSE DEATHS DUE TO COVID-19 AND THIS IS THE LARGEST GROUP TO DIE OF THE DISEASE WITHIN THIS SPECIFIC WORKFORCE SO THE DIFFERENCES ARE GIVEN BY DIFFERENCES IN EXPOSURE AND THERE'S A STRUCTURAL ISSUE TAKING PLACE HERE AND RATHER THAN A BIOLOGICAL ORIGIN ET TICK ONE. THERE ARE SEVERAL EMERGING ISSUES THAT ARE SPECIFIC TO WOMEN OF COLOR AND TO COVID-19 THAT MAY INFLUENCE HEALTH DISPARITIES SO WOMEN ARE PRIMARY CAREGIVERS WITHIN FAMILIES AND WOMEN OF COLOR MAY HAVE RESPONSIBILITIES FOR NOT ONLY THEIR CHILDREN BUT GRANDPARENTS AND FAMILY MEMBERS. THE PANDEMIC HAD HAD A NOTEABLE IMPACT ON THE CAREERS AND MOMENT AMONG WOMEN IN GENERAL AND THIS HAS AN ADVERSE IMPACT AMONG RACIAL ETHNIC MINORITY WOMEN AND I'M CONCERNED ABOUT THE MENTAL HEALTH OF WOMEN OF COLOR. THE LOAD AND THE WEATHERING THAT THE PANDEMIC IS LIKELY CAUSING AND I THINK WE NEED TO GET AHEAD OF SOME OF THESE MENTAL HEALTH CONCERNS THAT ARE GROWING DUE TO COVID-19. WE'RE DEALING WITH THIS PANDEMIC FOR AN EXTENDED PERIOD OF TIME AS WITH US MENTIONED BY ONE OF OUR DOCTORS AND IT'S A SHORT TERM CRISIS WHERE SOMEONE HAS AN OPPORTUNITY TO RECOVER. FOR MANY PEOPLE WHO HAVE LOVED LOVED ONES WHO ARE FACING MAJOR ECONOMIC HARDSHIPS WHO ARE UNEMPLOYED WHO HAVE MAJOR CONCERNS ABOUT CHILDCARE AND OTHER FACTORS, IT'S A DAILY REMINDER. WE SHOULD ALSO IN THE LITERATURE FOCUS A BIT MORE ON BIOLOGICAL FACTORS COMMON AMONG WOMEN AND AFRICAN AMERICAN WOMEN IN PARTICULAR AND I'M THINKING ABOUT OBESITY A MEDICAL CONDITION BUT THAT ALSO STEMS FROM MULTIPLE SOCIAL DETERMINANTS AND HAS SHOWN TO HAVE WORSE OUTCOMES FOR COVID-19. IN ANOTHER EXAMPLE, OF WOMEN'S HEALTH CONCERNS, NEXT. A PEW RESEARCH SURVEYS REPORTED THE PERCENT OF U.S. ADULTS WHO SAY THAT THEY WOULD DEFINITIVELY OR PROBABLY GET A COVID-19 VACCINE IF ONE WERE AVAILABLE TODAY. RESULTED BY GENDER, AGE AND EDUCATION SHOWED THE WILLINGNESS TO GET THE COVID-19 VACCINE BETWEEN MAY AND SEPTEMBER. IN IN A, AMONG WOMEN, 69% OF RESPONDENTS SAID THEY WOULD GET IT AND ONLY 45% RESPONDED THEY WOULD GET THE VACCINE. IF WE FOCUS ON RACE ETHNICITY THE SAME PATTERN IS APPARENT AND THEY'RE LESS WILLING TO GET THE VACCINE AT THIS POINT IN TIME SO THIS COMBINATION OF INSTITUTIONAL DISTRUST THAT IS WELL JUSTIFIED AND WELL PUBLICIZED RACIAL ETHNIC COVID-19 DISPARITIES AND VIRAL DISINFORMATION, HAS CONTRIBUTED AND CREATES A MAJOR UPHILL BATTLE THAT MUSTING ADDRESSED TO IMPROVE POPULATION HEALTH AND REDUCE HEALTH DISPARITIES. SO THE SCIENCE RESPONSE AND CRITICAL TO ADDRESS HEALTH DISPARITIES IN COVID-19 AND NIH HAS SEVERAL INITIATIVES ON GOING TO ADDRESS THE NEEDS OF UNDERSERVED AND VULNERABLE COMMUNITIES AND TO INCREASE TRUST IN SCIENCE AND THESE INITIATIVES HAVE HYPO TEN SHALL FOR IMPACT AND HAVE IMPLICATIONS FOR WOMEN'S HEALTH AND HEALTH DISPARITIES I WILL DESCRIBE TWO OF THEM THE FIRST IS THE RAPID ACCESS RACE OF DIAGNOSTICS UNDERSERVED POPULATIONS INITIATIVES AND THE SECOND IS THE COMMUNITY ENGAGEMENT ALLIANCE AGAINST COVID-19 DISPARITIES. SO RADX UP IS A $500 MILLION INITIATIVE TO STUDY COVID-19 TESTING AND SPECIFICALLY UNDERSERVED AND VULNERABLE POPULATIONS AND WE HAVE TO ENSURE THAT TESTING AND REPEAT TESTING AND REACHES THE GROUPS THAT ARE HARDEST HIT SO I CAN APPRECIATE WHAT DR. BRUCE WAS TALKING ABOUT WITH REGARD TO THE TECHNOLOGY CONTESTING AND CONTRACT TRACING SO THIS IS COMMUNITY ENGAGES RESEARCH PROJECTS FOCUSING AMONG INDIVIDUALS WHO MAY NOT HAVE THE PRIVILEGE OF BEING ABLE TO SELF-ISOLATE AND ADVANCE. RADX UP IS PRIORITIZING THOSE POPULATIONS UNDERSERVED INCLUDING RACIAL ETHNIC MINORITY GROUPS, SEXUAL AND GENDER MINORITY, DISADVANTAGES POPULATIONS AND UNDERSERVED RURAL COMMUNITIES AS WELL AS POPULATIONS THAT ARE COVID-19 VULNERABLE DUE TO MEDICAL GEOGRAPHIC AND SOCIAL FACTORS INCLUDING PREGNANT WOMEN AND CHILDREN. I'M EXCITED TO TELL YOU ABOUT SEAL. THE COMMUNITY ENGAGEMENT ALLIANCE AGAINST COVID-19 DISPARITIES. SO IT'S AN NIH WIDE INITIATIVE AND STOOD UP TO LEAD OUTREACH AND ENGAGEMENT EFFORTS INTO COMMUNITIES EFFECTED BY THE PANDEMIC. TESTIFY 11 TEAMS FOCUSED ON COVID-19 AWARENESS AND EDUCATION RESEARCH AND POPULATION THAT'S ACCOUNT FOR HALF OF ALL REPORTED CASES IN THE U.S. THE LOCATIONS CURRENTLY INCLUDE COUNTIES IN THE STATES YOU SEE LISTED HERE. SO THEY ARE LEVERAGING EXISTING NIH SUPPORTED INFRASTRUCTURE AND CAPACITY AND WORKING IMPORTANTLY WITH TRUSTED COMMUNITY PARTNERS AND TO ENHANCE EFFORTS TO PREVENT COVID-19 TRANSMISSION THROUGH INCREASED AWARENESS, EDUCATION AND OUTREACH. ALSO TO PROMOTE INCLUSION IN COVID-19 THERAPEUTIC AND VACCINE TRIALS AS WELL AS FOCUSING ON I IMPLEMENTATION EFFORTS. THIS IS THE WEBSITE WHICH INCLUDES RESOURCE THAT'S HELP EDUCATORS AND PROVIDERS AND LAY PERSONS CAN USE MORE ABOUT COVID-19 CLINICAL TRIALS. CLIN TAL TRIALS IN GENERAL AND RESEARCH PARTICIPATION. I ENCOURAGE YOU TO TAKE A LOOK AT WEB PAGE AND CHECK BACK. IT'S EVOLVING AND IT HAS USEFUL TOOLS. IS INVESTED IN THE SCIENTIFIC RESPONSE TO COVID-19. WE HAVE A SIGNIFICANT FOCUS ON COMMUNITY ENGAGE RESEARCH AND INCLUSION THIS SEWS AWARDS THUS FAR FOR RADX UP AND FOR SEAL. TOGETHER WE HOPE THESE INITIATIVES AND THOSE UPCOMING AND OTHERS THAT ARE ON GOING WILL CONTRIBUTE TO THE DIVERSITY IN RESEARCH AND SIGNIFICANT REDUCTION THIS IS COVID-19 HEALTH BIS PARTIES. SO I WANT TO THANK YOU AGAIN FOR IN INVITING AND INVITE YOU TO DECK THROUGH OUR WEBSITE AND ON SOCIAL MEDIA AND WE CAN NO MOVE ADDING YOUR QUESTIONS INTO THE CHAT. >> THANK YOU TO ALL OF OUR SPEAKERS. AND FOR INTRODUCE THEM. I WANT TO SEE THAT -- GO AHEAD AND MAKE A COMMENT. >> OK. >> THANK YOU EVERYONE. AGAIN, SOME GREAT PRESENTATIONS ON TOP OF THE THE MORNING AND I WANT TO COMMENT MR. ORWH FOR PUTTING TOGETHER SUCH A GREAT DAY SO FAR SO THANK YOU. I WANT TO DO A SHOUT OUT TO DR. SHAW. THANK YOU. THIS IS THE TOPIC NEAR AND DEAR TO MY HEART AS IF OUR TASK OF ADDRESSING SYSTEMIC RACISM IN PREGNANCY WASN'T HARD ENOUGH, WE HAVE COVID ON TOP OF IT AND THE FACT THAT IN CHICAGO, HOSPITALS ARE CLOSING ON THE SOUTHWEST SIDE FOR LATIN X AND AFRICAN AMERICAN POPULATIONS AND THE HOUSING INSECURITY AND LACK OF STABILITY AND THE FOOD INSECURE TEASE AND THE ACCESS TO CARE THAT THE KINDS OF JOBS PEOPLE HAVE TO GO TO. I APPRECIATE ALL THE BIOLOGICAL WORK THAT WE'RE HEARING ABOUT I'M HOPING SOME OF US MAY BE CAN GET TOGETHER AND THINK ABOUT HOW TO STUDY THESE OTHER FACTORS AS WELL BECAUSE IT'S ONLY COMPOUNDED THE HUGE DISPARITIES THAT WE'RE SEEING. I REALLY WANT US TO MOVE FORWARD AND THAT VENUE AS WELL. THANK YOU. >> I HAVE A QUESTION. >> GO RIGHT AHEAD. I HAVE A QUESTION FOR ALL THE SPEAKERS. ARE THERE ANY AREAS OF THE COUNTRY WHICH THERE ARE BETTER OUTCOMES THAN IN OTHER AREAS? OR IS THIS JUST NATION WIDE? ARE THERE SHINING LIGHTS WE CAN USE TO HELP US IN DOING BETTER? >> ONE THING MY TEAM DID OVER THE SUMMER AND HOPEFULLY WE'LL REPORT ON IT SOON, WE CONVENED CLINICIANS AS WELL AS BIRTHING PEOPLE THEMSELVES WHO GAVE BIRTH DURING THE PANDEMIC. PEOPLE ACROSS THE COUNTRY VIRTUALLY, TO TRY TO UNDERSTAND DIFFERENCES IN PRACTICE. THE INGREDIENTS OF INNOVATION, EVEN DURING A DIFFICULT MOMENT IS A DISRUPTION FOLLOWED BY DIFFERENT APPROACHES. TO A SET OF SHARED CHALLENGES AND WE DID FEES APART, YOU KNOW, THINGS THAT WERE CHALLENGING BUT SOME THINGS THAT PEOPLE WERE ABLE TO SOLVE BETTER THAN OTHERS AND THOSE WHO HAD EARLY EXPERIENCES OF THE VIRUS. THAT'S ALL ALL LEVELS FROM THE ABSENCE OF REALLY STRONG LET'S A NATIONAL OR IN SOME CASES STATE LEADERSHIP IT WAS LOCAL LEADERS AT THE CITY LEVEL AND HEALTH SYSTEM LEVEL THAT STEPPED UP AND HAD TO INNOVATE TO GET THE PEOPLE THE EQUIPMENT THEY NEEDED TO LEARN, FOR EXAMPLE, THAT FAKING CARE OF PREGNANT PEOPLE REQUIRED SUPPORTING THEM AND BEING RIGHT NEXT TO THEM AND THEY'RE OFTEN BREATHING HARD AND MANY OF TEM ARE POSITIVE BUT ASYMPTOMATIC AND THAT REALLY CREATES SYSTEM CHALLENGES, AGAIN, THAT I THINK PEOPLE HAVE SOLVED FOR AND THERE'S A LOT TO LEARN FROM AS WE COME INTO A THIRD WAVE NOW. THE WEEKS AND MONTHS AHEAD WILL BE CHALLENGING. THERE'S A LOT TO BE LEARNED FROM HEALTH SYSTEMS IN NEW YORK CITY AND MASSACHUSETTS AND SEATTLE. >> I CAN MAKE A QUICK COMMENT. SOME OF MY COLLEAGUES WENT TO NEW YORK CITY WHEN THEY NEEDED MORE HEALTHCARE PROVIDERS AND THE PLACE THAT'S WERE MOST HEAVILY HIT REALLY DID COME UP WITH STRATEGY THAT WERE HELPFUL AND ONE OF THE CHALLENGES IS IN THE UNITED STATES THE CDC SHOWS DATA BUT IT DEPENDS ON THE STATES AND LAWS SO NOT BEING ABLE THE STATES AND ARE PRESENTING THEIR DATABASE ON SEX SO IF WE HAD THAT AS A NATIONAL AND GUIDE I THINK WE CAN GET EVEN MORE DATA AND THE DIFFERENT STATES AND CITIES BUT IT'S TOO, YOU KNOW, IT'S STATE DEPENDENT RIGHT NOW. THANK YOU, THESE WHY GREAT TALKS. I APPRECIATE IT. >> THANK YOU SO M I MAY HAVE MISSED IT BUT I DIDN'T HEAR ANYONE MENTIONING OTHER HEALTH SERVICES SO SUCH CLOSELY CONNECTED TO MATERNAL HEALTH AND IT MAY HAVE BEEN EFFECTING DURING THE COVID PANDEMIC. IN PARTICULAR IN PLANNING SERVICES AND ACCESS TO A SAFE ABORTION AND THERE ARE SOME PROTECTIONS AND DONE THAT SHOW THE LARGE INCREASE THAT WE WILL SEE IN MISS TIME AND WANTED PREGNANCY AND THE CONSEQUENCES IT HAS BIOLOGICAL AND SOCIAL ON WOMEN, FAMILIES AND CHILDREN ULTIMATELY. I WONDER IF THERE'S SOMETHING THAT WE KNOW ABOUT THAT THE U.S. THAT WE MAY HAVE MISSED AND IF THERE'S SOMETHING THAT IS CURRENTLY BEING DONE TO INCREASE THE INDIVIDUAL ACCESS TO THAT WIDER RANGE OF SERVICES. IN UNDERSERVED POPULATIONS. >> WHY HAVE A LOT TO ADD AND TO COSINE AND MANY NOT FIE THE POINTS AND MY UNDERSTANDING IS THAT THE SAME CONCERNS WE HAVE GLOBALLY WE HAVE CONCERNED TO BE DOMESTICALLY AS WELL AND WE DID SEE AMID THE PANDEMIC A LOT OF LABELING OF SERVICES AS ESSENTIAL AND NON ESSENTIAL AND WE SAW CHALLENGES TO ACCESS TO ESSENTIAL REPRODUCTIVE SERVICES AND SO, I CERTAINLY SHARE THOSE CONCERNS WE'VE HEARD FROM A COUPLE PEOPLE THAT THE PARTNER VIOLENCE IS GOING UP AND THE MEMBER HEALTH OF WOMEN BECAUSE OF THE STAY AT HOME ORDERS IS GOING UP AND THERE'S MORE CALLS INTO HOTLINE AND THERE IS LESS ACCESS TO SHELTERS FOR WOMEN AND EXACTLY RIGHT, IT'S BECAUSE OF POLITICAL ENVIRONMENT OR WHO IS ESSENTIAL OR IF THERE'S AN OUTBREAK AND THAT'S BEEN CHALLENGING FOR WOMEN. >> I BELIEVE WE HAVE ANOTHER QUESTION. I WANT TO THANK DR. HOOPER. SHE HAD A HARD SHOP AND SHE'S HEADED TO ANOTHER PRESENTATION SO THANK YOU SO MUCH WE LOOK FORWARD TO HAVING MORE CONVERSATIONS WITH YOU IN THE FUTURE. >> THANK YOU, IT WAS MY PLEASURE. AND I ENJOYED IT. THANK YOU, EVERYONE. HE IS CITING A PAPER THAT REPORTED HIGH AGE TO EXPRESSION IN THE MATERNAL INTERFACE CELLS AND CITED AND THEY ARE WONDERING, THERE THERE IS SO MUCH HIGH ACE TO EXPRESSION THERE WHY DON'T WE SEE A POOR OUTCOME IN PREGNANT PEOPLE? >> THAT'S AN EXCELLENT QUESTION AND I DID READ THAT PAPER WITH CENTER AND I DON'T KNOW AND WE HAVE REAL EXPERTS ON THIS COMMITTEE SO I'M CURIOUS IF ANYBODY ELSE HAS ANY THOUGHTS BUT I FIND THAT PERPLEXING AS WELL. >> I WAS SATURDAYING TO TYPE SOMETHING AND -- >> SO WHAT WE'RE FINDING IS THAT THIS VIRUS, UNLIKE ZIKA, WHICH DISSEMINATED TO MANY TISSUES, AND WAS ABLE TO INFECT CELLS WE ARE REALLY PREDOMINANTLY FINDING THE VIRUS IN THE LUNGS AND YES, OTHER TISSUE CAN BE INVOLVED BUT WE'RE NOT THE VIRUS IS NOT GETTING THERE. FLU DOES NOT INFECT OR CROSS THE PLACENTA BUT IT CAN CAUSE PROBLEMS BECAUSE THE DISEASE CAN INVOLVE OTHER TISSUES. IT POINTS TO HOW MUCH WE DON'T UNDERSTAND AND COMPLICATED PREGNANT PERSON'S PHYSIOLOGY AND PATH OF PHYSIOLOGY AND AND HOW IMPORTANT IT IS FOR A INTERNET DISCIPLINARY APPROACH TO BE TAKEN, ESPECIALLY IN THIS CONTEXT. WE ARE A LITTLE OVER. I WANT TO MAKE ONE LAST COMMENT IF THERE'S SOMETHING THAT YOU DIDN'T GET TO MENTION THAT YOU WOULD LIKE TO MENTION BEFORE WE MOVE TO THE NEXT ITEM. NEEL AND ALLISON WE WILL TALK ABOUT THESE ISSUES FOR SOME TIME TO COME AND I KNOW WE CAN COUNT ON YOU TO HELP US THINK OF THESE CHALLENGES ISSUES BUT ANY LAST WORDS BEFORE WE MOVE TO THE NEXT ITEM, ALLISON OR NEIL? >> THERE'S SO MUCH TO TALK ABOUT AS I MENTIONED. THE ONE THING I WANT TODAY SAY WITH THE LONG-HAULERS SO IF WOMEN ARE LESS LIKELY TO BE HOSPITALIZED THEY'RE MORE LIKELY TO BE THE LONG-HAULERS BUT HERE IS THE THING. WE'RE NOT TESTING NON HOSPITALIZED PATIENTS SO IN THE EMERGENCY DEPARTMENT, IF YOU COMMIT AND YOU ARE NOT THAT SICK WE DON'T HAVE ENOUGH TESTING FOR EVERYBODY AND WE TELL TO YOU GO HOME AND QUARANTINE AND TAIR RADA CAKE OF YOURSELF SO THERE'S A FAKE PAGE ON THE HALL AND HE IS IT'LONG-HAULERS.THESE WOMEN ARE GOING T O THEIR DOCTORS AND THEY'RE SAYING THAT THEY HAVE FATIGUE AND THEY FEEL SHORT OF BREATH AND ALL OF THESE SYMPTOMS AND THEY'RE HOLD IT'S ANXIETY FROM THE PANDEMIC AND THEY DON'T HAVE A POSITIVE TEST IN THEIR RECORD AND SO IT IS CONCERN OF MINE WHERE A PSYCHOLOGICAL DIAGNOSIS WILL BE GIVEN INSTEAD OF A PHYSICAL LOGIC ONE SO WE NEED TO HAVE A HARD CRITERIA OF WHAT THE SYSTEMS ARE AND HAVE PROGRAMS TO ASSIST MEN AND WOMEN. >> I'M LUCKY TO FOLLOW DR. McGREGOR AND OTHERS WHO HAVE BETTER THINGS TO SAY BECAUSE I CAN AMPLIFY THAT POINT AND OUR UNDERSTANDING RIGHT NOW OF HOW COVID-19 IMPACTS PEOPLE IS BASED ON DENOMINATORS ESPECIALLY WHEN WE TALK ABOUT RATES AND THAT IS WHO IS GETTING TESTED AND WHO HAS IS ACCESS TO AT THE TIMING AND IT'S CRITICAL HOW WE GENERALIZE WHAT WE'RE LEARNING ESPECIALLY IN THE MONTHS AHEAD. >> WE DID HAVE PRESENTATIONS HIGHLIGHTING ALL THE INCREDIBLE WORK BEING DONE REGARDING TESTING DEVELOPMENT BUT OF COURSE IF THE TEST DOESN'T GET TO THE PEOPLE THAT NEED IS WHICH IS ESSENTIALLY EVERYONE, THEY CAN'T HAVE THEIR INTENDED EFFECTS. THANK YOU FOR THIS AMAZING PRESENTATION AND WE CAN DISCUSS IT DURING OUR OPEN DISCUSSION TIME IF THERE THERE ARE FURTHER POINTS THAT NEED TO BE MADE SO WE'LL MOVE THAT TO THE DISCUSSION TIME. AT THIS POINT, I WANT TO INTRODUCE DR. SAMI DORSEY AND GIVE DR. BEGG AND I WANT TO GIVE DR. BEGG HER FULL 30 MINUTES. >> THANK YOU, JEANNINE. HI, EVERYONE. AS I'M PLEASED TO INTRODUCE OUR NEXT PRESENTER WHO WILL BE SHARING WITH YOU A PRELIMINARY REPORT ON THE BUILDING AND ENTER DISCIPLINARY CAREERS IN WOMEN'S HEALTH AND THE PROGRAM. OVER HER CAREER, DR. BEGG HAS WORKED AS A SENIOR INSTITUTES AND CENTERS TO DEVELOP AN ENHANCE A VARIETY OF INITIATIVES AND SEX DIFFERENCES RESEARCH INCLUDING SEVERAL NIH WIDE AND FEDERAL INITIATIVES AND DR. BEGG CREATED A LARGE BREAST CANCER RESEARCH PROGRAM WITH SUPPORTS FROM EIGHT EXTRAMURAL RESEARCH PLANS AND CONTRACTS AND SHE ALSO TALKED ABOUT AND STUDENTS AND HEALTH FACULTY POSITIONS IN THE SCHOOLS OF PUBLIC-HEALTH MEDICINE AND NURSING. EARLIER IN HER CAREER SHE FOUNDED THE ONCOLOGY SOCIETY WHICH NOW HAS OVER 39,000 MEMBERS WORLDWIDE IT'S MY PLEASURE TO INTRODUCE DR. BEGG. >> CAN YOU HEAR ME OK? >> COMING IN LOUD AND CLEAR. THANK YOU. THIS TRULY HAS BEEN A WONDERFUL MEETING AND IT IS MY PLEASURE AND OPPORTUNITY TO GIVE YOU A PRELIMINARY READ OUT SO TO SPEAK OF THE EVALUATION THAT WE'VE JUST COMPLETED FOR THE BIRCH PROGRAM. I WANT TO HIGHLIGHT THE DOCTOR IS ONED VIDEO SO I CERTAINLY WELCOME HER INPUT AND COMMENTS AND SHE'S WORKING WITH US AS A TEAM. NEXT SLIDE, PLEASE. TO GIVE YOU AN IDEA OF HOW I WILL RUN THROUGH THE SLIDES, NOT EVERYONE IS IF I AM WITH THE BIRCH HISTORY SO I WILL COVER THAT BRIEFLY AND MANY COMPONENTS OF THE EVALUATION PROJECT ITSELF AND PROBLEM OUTCOMES AND THE SUCHS WE SURVEYS SCHOLARS AND MENTORS AND THEN A SAMPLING IN TERMS INSTITUTIONS AND WE DID COME UP WITH PRELIMINARY CONCLUSIONS AND WE WELCOME INPUT FROM YOU NOW AND LATER ON AS WELL. IT'S KID A SIGNATURE PROGRAM OF ORWH AND IT WAS CREATED IN 1999 TO A CONGRESSIONAL ONE-TIME APPROPRIATION AND DR. CLAYTON COVERED SOME OF THE HISTORY OF ORWH SO CONGRESS WAS ACTIVE WITH ORWH AND EARNED ABOUT PIPELINES WHETHER ENOUGH RESEARCHERS IN THE PROCESS OF GOING TO CAREER SO IT WAS A 15 MILLION-DOLLAR CONTRIBUTION IN 1999 AND THE FIRST AWARDS WERE MADE IN 2000. THIS YEAR IS THE 20th ANNIVERSARY AND WE WILL WE'LL CELEBRATE THAT DECEMBER 14th. IT USES THE K-12 AND IT IS USED BY SEVERAL INSTITUTES ACROSS NIH AND CONSIDERED A MENTORED CAREER DEVELOPMENT INSTITUTIONAL GRANT AND WE HAVE CALLED OUR TRAINEES SCHOLARS AND THEY ARE AT THE JUNIOR FACULTY LEVEL AND THAT IS DIFFERENCES IN LEVELS OF TRAINEES WITH THE K-12 ACROSS THE NIH AND THIS DECISION WAS MADE IN '99 AND 2000 AND HELD ABOUT THE WHEN WE GO OVER THE DATA. THESE ARE COMMITTED MEN AND WOMEN TO STUDY WOMEN'S HEALTH RESEARCH AND SEX AND GENDER DIFFERENCES AND SO THEY'RE IMPORTANT. THE PROGRAM WAS CREATE INSIDE 2000 AND WE PARTNERED ACROSS A NUMBER OF INSTITUTES AND CENTERS AND I HAVE AN ACKNOWLEDGMENT ON THE LATER SLIDE. BACK IN 2000, THE TEAMS WAS UNUSUAL AND IT WAS CREATED BY WISH OF ANBIRCH AND WE'VE STUCK BY IT. THEY'RE ALL REPRESENTED IN THE EVALUATION AND IN THE SCHOLARS WHO HAVE GRADUATED, NEXT SLIDE, PLEASE. WE APPRECIATE THIS. THERE WAS A FOCUS GROUP INITIALLY AND IT WAS MADE UP OF K-12 PROGRAM OFFICIALS AS WELL AS K-12 RECIPIENTS EXTRAMURAL AND SO TO GET SOME IDEA HOW TO BEST START THE RESEARCH EVALUATION PROJECT, WE DID INTERVIEWS WITH SIX OF THE P.I.s AND THERE'S OUTCOME DATA FOR THE SCHOLARS, THE P.I.s, THE MENTORS AND THE INSTITUTIONAL PROGRAMS AND THIS WAS DONE BY SURVEY AND PRIVACY AND AGREEMENT AND APPROVAL WAS OBTAINED THROUGH NIH PRIVACY OFFICES. AND WE LOOKED AT MODELS SUSTAINABILITY AND WHETHER IT WAS LEVERAGED ACROSS THE INSTITUTIONS AND I HAVE SOME DATA ON THAT AND IN TERMS OF THE SURVEYS, THE SURVEYS WERE DONE JUST ABOUT A YEAR AGO AND WE WERE ABLE TO COVER ALL THE BIRCH PROGRAMS AND 80 OF THE MENTORS SAMPLING OF THE SCHOLARS 400, 391 ACTUALLY AND ALL THE P.I.s. AND THE ANALYSIS WAS COMPLETED OVER THE SUMMER AND I'M HAPPY TO REPORT OUR PRELIMINARY RESULTS. SO THE GROUPS SURVEYED OVER THE 18 YEARS SO WE STOPPED AT 2018 BECAUSE THAT WAS THE LAST FOUR YEAR WE HAD DATA. THERE WAS 88 GRANTS MADE TO 44 INSTITUTIONS SUPPORTING 687 JUNIOR FACULTY THE SCHOLARS FOR THE 18-YEAR PERIOD. WE ALSO IDENTIFIED # 2PIs FOUR OF WHOM HAD BECOME THEY HAD DIED SO WE HAD 88 WITH A RESPONSE RATE OF 64% AND THEY REPRESENTED THE PROGRAMS. THE SAMPLE OF THE 391 OF THE SCHOLARS REPRESENTED THE BIRCH INSTITUTIONS SO WE WERE PLEASED ABOUT THAT AND WE HAD A GOOD RESPONSE RATE OF 72% FOR THE SCHOLARS AND THE MENTORS WERE RECOMMENDED BY THE P.I.s AND I CAN GO INTO THAT A LITTLE LATER. WE HAD HUNDREDS OF P.I.s ASSOCIATED WITH THE BIRCH PROGRAMS SO WE WEREN'T SURE HOW TO IDENTIFY THE P.I.s WHO WERE MOST EXPERIENCED IN MENTORING THE SCHOLARS SO WE HAD A 79 RESPONSE RATE SO THAT WORKED OUT WELL TOO. BEFORE THE SURVEYS WERE CREATED, AND I WENT IN NOR THAT IN TERMS OF THE EXPERTS, THE NEXT SLIDE, PLEASE. SO THE KEY QUESTIONS AND I'M GOING TO HIGHLIGHT HALL OF THESE BUT SEVERAL ARE IMPORTANT AND IT WAS A PRIMARY FOCUS AND THE PLUCK OF THE PROGRAMS AND SO WE HAVE DATA ON A PRELIMINARY BASIS ON THAT AND WE ALSO HAVE INFORMATION ON THE CAREER TRAJECT TO BE TEE FORCE THE P.I.s AND THE MENTORS AND WE HAVE BEGINNING DATA ON UNDER REPRESENTED MINORITIES WHO WERE RECRUITED THROUGH THE BIRCH PROGRAM AND WE'RE PLEASED ABOUT THAT AS WELL. THE ADVANCEMENT IS ALSO COVERED AND HOW THE INSTITUTIONS LEVERAGED THE BIRCH PROGRAM. SO THE 18-YEAR PERIOD WAS COVERED AND SAMPLING OF THE P.I. SCHOLARS AND MENTORS AND THE SURVEY RESULTS WERE INTERNET SENT TO EACH SCHOLAR P.I. AND MENTOR AND WE AUGMENTS THE SCHOLAR INFORMATION SURVEY INFORMATION WITH THEIR CURRICULUM AND THE PUBLIC DATABASE AND THE NIH DATA FILES I PUT IN THERE BECAUSE I ACTUALLY GET INTO I WANTED TO CONFIRM THE FINDINGS AND THE NIH DATA WHICH ARE NOT PUBLIC. THE LIST OF PIR MUCH SCHOLAR PUBLICATIONS WE HAVE PUBLICATION AND THE INCOMPETENT HAVE YOU TRANSCRIPT FROM THE THOSE WERE HOUR AND A HALF PHONE SURVEYS AND STANDARD QUESTIONS AND PROMPTS AND A LOT OF DETAILS AND A LOT OF TEXT RESPONSES. NEXT SLIDE. SO I'M GOING TO INTO THIS GROUP FIRST. WE HAD 282 THAT RESPONDED BACK AND 262 THAT DID EXTENSIVE SURVEY COMPLETION AND MOST OF THEM GAVE US CDs AND WE HAVE A DATA ON THEM AND THERE WERE 20 THAT ONLY COMPLETED PARTIAL SURVEYS BUT WE COMPLETED THEM TO THE EXTENT WE COULD AND YOU CAN SEE THERE'S A DESEPTEMBER NUMBER FOR THE VARIOUS BUCKETS AND AND ON WITH 2018 AND NEXT SLIDE. THEY ELEMENTED THE PROGRAM BY GENDER AND THE SCHOLARS WERE RETURN 30 AND 39 AND WE HAVE 80% OF THE DOLLARS FEMALE AND 20% MALE AND YOU CAN SEE THERE AND THERE'S SOME THAT DID NOT WANT TO REPORT. THESE ARE MORE MATURE RESEARCHERS AND SO THE FACULTY LEVEL. NEXT SLIDE, PLEASE. I DUBBED THE TERMINAL DEGREE FOR LACK OF A BETTER TERM FOR THIS AND IF YOU LOOK AT THE PHD AND I REFERRED TO THAT AS ANY PHD, PHD OR THAT SORT THING AND THAT ACCOUNTED FOR THIS COULD BE MD, SO ON AND SO FOURTH THAT'S ABOUT 42% SO THE VAST MAJORITY OF COVERED BY THESE TWO CATEGORIES AND WE ALSO DID ADMIT A COUPLE WHO HAD MPHs AND I'M NOT WORK AND WE DON'T HAVE THE DATA ON THAT AND YOU CAN SEE FROM THE OTHER, WE DID DR. PUBLIC-HEALTH AND FARM D AND IS HE IF TERMS OF RACE AND ETHNICITY, WE DID WANT TO CAPTURE UNDER REPRESENTED MINORITIES WHICH HAS ANOTHER DEFINITION BY NIH THAT INCLUDES PEOPLE WHO ARE BLACK OR AFRICAN AMERICAN AND AMERICAN INDIAN AND ALASKA NATIVE, NATIVE HAWAIIAN OR PACIFIC ISLANDER AND HISPANIC OR LATINO. THAT'S THE DEFINITION THAT THE NIH USES FOR THE ENTIRE PERIOD, WE DID 13% OF THE SCHOLARS AND INDICATED THAT THEY WERE FROM THIS CATEGORIES AND THERE WERE 19 SCHOLARS WHO ELECTED NOT TO PROVIDE THE INFORMATION AND NEXT SLIDE, PLEASE. CAN YOU SEE THAT THERE WAS A DIFFERENCE. ONLY 3% WERE IDENTIFIED THEMSELVES AS UNDER REPRESENTED MINORITIES AND THE MOST RECENT YEAR, 2015 TO 2018, IT WAS UP TO 21%. SO WE'RE PLEASED ABOUT THAT. AND THIS GIVES YOU SOME IDEA OF THE NUMBERS SO OF THE 35 UNDER REPRESENTED MINORITIES, THE VAST MAJORITY OF WOMEN 33 OF THEM, TWO MEN SO YOU CAN SEE THIS AGAIN AND NOTE THE 19 THAT DID NOT PROVIDE INFORMATION TO US, NEXT SLIDE. THERE WAS SOME INTEREST IN TRYING TO LOOK AT THE CAREER TRAJECTORY AND OF THE 35 SCHOLARS WHO WERE AND WE WERE LOOKING AT SOME FIGURES AND IT LOOKS LIKE THAT'S ACTUALLY ABOVE WHAT WOULD BE CONSIDERED REGULAR 10-YEAR RATES AND WE'LL INVESTIGATE THIS A LINT MORE AND 19 OF THE 35 ACHIEVED LEADERSHIP AND THIS IS AN EXAMPLE OF SOME OF THE LEADERSHIP POSITION THAT'S THEY DESCRIBED IN THE DATA AND ASSOCIATE AND DIRECTOR LEVEL AND ASSOCIATE PROFESSOR AND IF YOU COMBINE THE TWO IT'S 23% EIGHT OUT OF 35 THAT HAD THE LEADERSHIP POSITION. SO WE'RE PLEASED ABOUT THAT NEXT SLIDE. SO ONE OF THE KEY OUTCOMES FOR THE EVALUATION WAS HOW SUCCESSFUL WOULD THEY BE IN TERMS OF OUR LEVEL NIH GRANTS AND THE BIG ONE IS R01 AND R21 AND R03 AND R15 FITS IN THERE SO THOSE ARE THE GRANTS THAT WE WERE LOOKING TO ASCERTAIN AND WE USE PRIMARILY THE NIH REPORTER TO LOOK AT THIS SO THE GOOD NEWS IS THAT 70% OF SCHOLARS REPORTED GRANT AND ASK ANOTHER 18% HAD FIVE TO 10 GRANTS AND THERE WAS 7% WITH 10 OR MER SO I CAN GET IN THIS LATER BUT THE ONES THAT HAVE A LARGE NUMBER OF R-LEVEL GRANTS WERE PART OF RESEARCH TEAMS AND SO IT IS THE NATURE OF THE TRAINING THEY RECEIVE TRAINING THEY RE CEIVED. 67% OF SCHOLARS PROVIDED CVs SO THAT'S ONE OF THE THINGS, IS WHY WE WANT TO GO BACK AND OBTAIN THE CBs FROM THE REMAINING ONE-THIRD OF THE SCHOLARS BUT THEY SOUND JUST YOU CAN SEE HERE THAT THEY WERE PROLIFIC AND THE MEETING PER SCHOLAR MEAN OF 45 AND THERE'S A NUMBER THAT WERE HIGHLY PRODUCTIVE AND A LONG TAIL OUT AND SO I CAN SEE FROM THE STANDARD DIS PRACTICE BUSTA IT WOULD RANGE FROM ONE PUBLICATION TO 287 PUBLICATION AND THE LONGER YOU WERE POST BURG THE MORE YOU HAD AS WELL. WE MADE A TOP 11 BECAUSE THE OBESE TEE WERE EQUAL IN TERMS OF THE NUMBER OF PUBLICATIONS AND THE UNIQUE NUMBER OF SCHOLARS AND THERE IS DIABETES AND ARTHRITIS AND JOURNAL OF WOMEN'S HEALTH AND AMERICAN JOURNAL OF EPIDEMIOLOGY AND GERIATRICS AND OBESITY AND WHAT WE'RE GOING TO DO WITH THIS IS WE ARE GOING TO WORK WITH OUR COLLEAGUES AND THE NATIONAL LIBRARY OF MEDICINE AND TO LOOK CLOSELY BECAUSE THE FIGURE OF THE TOTAL NUMBER OF DIFFERENT PUBLICATIONS THAT SCHOLARS PUBLISHED IN WERE 2,000 JOURNAL BUT IT'S OUR INHOUSE SO WE'LL WORK WITH THEM TO ASCERTAIN THE IMPACT OF THESE VARIOUS JOURNALS. NEXT SLIDE, PLEASE. MOVE STAYED I IN ACADEMIA AND 15 WEPT INTO INDUSTRY. THIS COULD BE NON-PROFIT OR FOR PROFIT INDUSTRY. THERE WAS A FAIR NUMBER OF QUESTIONS AND CHOICES AND WE WANT TO LOOK AT THAT FURTHER AND 1%, 1% WENT INTO GOVERNMENT AND WE HAVE A COLLEAGUE HERE AT NIH THAT WAS A SCHOLAR AND PROBABLY EIGHT YEARS AGO SO SHE'S ONE OF OUR DEAR COLLEAGUES, NEXT SLIDE, PLEASE. THE GRANDS AWARDED TO THE SCHOLARS POST BIRCH SO THIS IS OTHER GRANTS AND SO, THERE'S ONE-THIRD OF THE SCHOLARS OBTAINED A CASE SERIES GRANT POST PIR MUC BIRCH SO A LOT WENT ON TO GET OUR LEVEL GRANTS AND A THIRD MOVED DOWN THE NEXT STAGE WAS THE INDIVIDUAL K WHICH ARE MEN FORWARD TO GRANTS. 77% OF THE SCHOLARS THAT WAS SEEK FOR MEN AND WOMEN IN THE PROGRAM UTILIZED FOUNDATION GRANTS AND INSTITUTIONAL GRANTS AND OTHER TYPES OF GRANTS POST PIR MUCH SO IT'S A CREDIT TO THE INSTITUTIONS THAT THERE WAS THIS WHOLE SET UP TO SUSTAIN THE SCHOLARS POST THEIR TRAINING PROVIDING THEM BASICALLY WITH A SMALL FOUNDATION GRANTOR INSTITUTIONAL FEED MONEY SO THEY WOULD BE COMPETITIVE FOR NIH GRANTS AND OTHER TYPES OF GRANTS SO WE'RE PLEASED ABOUT THAT AND JUST TO NOTE BECAUSE SOME PEOPLE ASKED ABOUT IT 12% OF THE SCHOLARS RECEIVED AN F-SERIES GRANT PRIOR TO BE A WIS BIRCH SCHOLAR SO I WANTED TO INCLUDE THAT. NEXT SLIDE, PLEASE. THERE WERE 92P.I.s AND OVER THE 88 GRANTS AND 44 INSTITUTIONS AND BECAUSE OF THE LONGEVITY OF THE MANY OF THESE PROGRAMS THERE WERE CHANGES OVER THE 18 YEAR PERIOD AND INCREASINGLY MULTI P.I.s THAT WE SEE NOW AND RESPONSE RATE WAS 64% AND BECAUSE I WANTED TO GET THE RESPONSE RATES UP TO AT LEAST 07%, I WOULD SEND E-MAILS AND I WOULD REACH OUT AND CALL OR WORK WITH THE CURRENT P.I. AND SEE IF WE CAN SECURE THE COOPERATION AND PEOPLE MADE A VALID EFFORT AND WE HEAR IT'S TOO FAR IN MY PAST AND I'M NOT SURE WHAT IS GOING ON AND SO THE 64% REPRESENTS WHAT WE CAN GET THERE. HONG ON A SECOND. HOPEFULLY IT WILL BE FINE. THERE WE GO. THERE WE GO. ALL P.I.s WHO PARTICIPATED IN THIS SURVEY REPORTED THAT THEIR SCHOLARS HAD A PRIMARY MENTOR WHICH IS PART OF THE REQUIREMENTS FOR THE PROGRAM AND SOME HAD CAREER MENTORS AND SCIENTIFIC CONTENT MENTORS AND THIS IS WHAT WE WANT TO DISCUSS FURTHER. NEXT SLIDE, PLEASE. THIS IS AN INTERESTING SLIDE AND IT GETS INTO THE LEVERAGING OR SYNERGY SO THE P.I.s ARE HELPFUL HERE. A NUMBER OF THEM HAVE OTHER K12s AND THEY HAVE KL2s AND P30s, THIS IS A DYNAMIC GROUP OF PIs AS WELL AS IN PROPOFOL YEARS SO WE DID MAP AGE TO RECRUIT PIs TO RUN THESE PROGRAMS AND WE'RE PLEASED ABOUT THAT. SOME OF THE SYNERGY AND THIS IS TRUE FOR PAST PROGRAMS AS WELL AS THE CURRENT ONES AND THAT IS EVEN IF IT'S ONE SCHOLAR AND THERE ARE SCHOOLS OF COMMUNICATION AND SO FOURTH. THE P.S. INDICATED THEIR INSTITUTION HAS BENEFITED IN TERMS OF THIS INTERNET DISCIPLINARY RESEARCH FOCUS AND MENTORING OPPORTUNITIES AND THE GREATER FOCUS ON WOMEN'S HEALTH AND A THIRD INDICATED THE COLLABORATION WAS WITH HISTORICALLY BLACK COLLEGES AND EFFORTS AND THE NEXT SLIDE. IF I COUNT IT THERE'S SIX PROGRAMS THAT HAVE THESE FORMAL PARTNERSHIPS AND I'D LIKE TO ACKNOWLEDGE THEIR WORK TO SET UP THESE NORMAL PROGRAMS AND INDICATE THE OTHER PROGRAMS THAT DIDN'T HAVE FORMAL PROGRAMS WERE ABLE TO RENINE OR TEASE SO IT'S ACROSS ALL BIRCH PROGRAMS THAT THESE PROGRAMS WE WANTED TO HIGHLIGHT AS HAVING GONE THE EXTRA MILE SO TO SPEAK. IN THE CONCLUSIONS I WOULD LIKE TO INDICATE THAT WE WOULD LIKE TO ENHANCE THIS IN WORKING WITH ALL MINORITY SERVING INSTITUTIONS TO SEE WHAT OTHER ARRANGEMENTS ACROSS THE NIH THAT WRACK WORK WITH AND OFF WITH THE BIRCH PROGRAMS THEMSELVES. NEXT SLIDE, PLEASE. THE THIRD GROUP IS THE BIRCH MENTOR. WE IDENTIFIED WE WENT BACK TO THE P.I. AND SAID COULD YOU GIVE US THREE TO FIVE MENTORS YOU KNOW HAVE HAD EXPERIENCE MENTORING THE SCHOLARS AND THAT'S HO WE CAME UP WITH THE 80 MENTORS AND WE DID GET 9% RESPONSE RATE AND SO WORE PLEASED WITH THAT AND NEXT SLIDE, PLEASE. THE MESH TO BE SURVEY HERE. SO THE MENTORING 79% ENCOURAGED NETWORKING OPPORTUNITIES AND THEY WORKED HARD ON THAT AND THEY RECEIVED PROFESSIONAL BENEFITS AS WELL AS THE SCHOLARS AND IT AFFECTED THEIR RESEARCH AND I THOUGHT THAT WAS AN INTERESTING THING AND 70% INDICATED THAT THE PARTICIPATION AS A MENTOR, PROMOTED MORE INCOMPETENTER DISCIPLINARY RESEARCH ON THEIR PART AS WELL. IT WAS A NICE SYNERGY THERE AS WELL. NEXT SLIDE. THIS WAS OBTAINED FROM SEVERAL SOURCES BUT MOST OF IT CAME FROM THE SUR VASE OF THE SIX BIRCH P.I.s AND SO THE RESEARCH WAS INCREASED ACROSS THE BIRCH PROGRAMS AND THERE'S ALSO NEW PROGRAMS THAT FOCUSED ON WOMEN'S HEALTH THAT WERE CREATED ACCIDENT TO THE BIRCH GRANT AND SO AGAIN, THIS WAS A BEVERAGING AND THE NUMBERS DROPPED DOWN BUT THE P.I.s ALSO INDICATED THAT THERE WERE NEW COURSES AND NEW CONTENT AND NEW SCIENTIFIC COMMITTEE SO WE'RE PLEASED WITH THIS IN TERMS OF A PRELIMINARY START AND THERE IS A LOT MORE DATA THAT HAS TO BE ANALYZE AND WE LOOK FORWARD TO REVIEWING THAT AND WORKING WITH THE P.I.s IN OUR COLLEAGUES ACROSS THE NIH. IN TERMS OF PRELIMINARY CONCLUSIONS, THERE WAS SUCCESS ON THE PART OF THE BIRCH SCHOLARS DUE TO THE VARIOUS LEVELS OF FUNDING THEY HAD GOTTEN AND THE MULTIPLE JOURNAL PUBLICATIONS IN MEDICAL JOURNALS, AND HEALTH RELATED JOURNALS. IT WAS BENEFICIAL TO THE MEN TEES AND THE MENTORS AND THE INSTITUTION BENEFIT THROUGH INTERNET DISCIPLINARY RESEARCH AND SUPPORT SO WE'RE SO WE HAVE TO DO MORE AND I ALLUDE TODAY THIS AND NATIONAL LIBRARY OF MEDICINE WE'RE GOING TO WORK WITH IN TERMS OF LOOKING AT THE IMPACT OF THE VARIOUS PUBLICATIONS BECAUSE THERE ARE SO MANY JOURNAL AND PUBLICATIONS WE WANT A BETTER HANDLE ON THAT AND WE ALSO WANT TO LOOK AT THE CAREER ADVANCEMENT FOR ALL THE SCHOLARS AND THE UNDER REPRESENTED MINORITIES. THE 15% OF SCHOLARS THAT WENT INTO INDUSTRY IS SORT OF A INTERESTING FINDING AND WE LOOK AT THAT A LITTLE BIT MORE BECAUSE THAT MAY REPRESENT A HYBRID CAREER PATH AND WE WANT TO PURSUE THAT AND WE WANT TO LOOK AT WAYS TO INCREASE THE PARTICIPATION OF THE HBCU HISPANIC SERVING INSTITUTIONS AND OTHER MINORITY SERVING INSTITUTIONS WITH THE BIRCH PROGRAM. THAT WAS NOT AN ORIGINAL BOWL GO WE WANT TO BE PART OF THE SOLUTION AND SO WE A STRONG FOUNDATION RIGHT NOW OF WORKING WITH VARIOUS MINORITIES SERVING I GUESS TUESDAYS AND WE WOULD LIKE TO EXPAND AND SUPPORT IT AND ANALYZING DATA FURTHER 71% OF THE SCHOLARS. I PUT THIS IN, 71% OF THE SCHOLARS SELF-REPORTED THEY PERSUADE WOMEN'S HEALTH RESEARCH, PARTICIPATION AS YOU CAN SEE, IT'S DIFFERENT DEFENDING ON FEMALE VERSUS MALE AND MOST PEOPLE THOUGHT 71% WAS HIGH I THOUGHT IT WAS AN UNDER REPORTING AND I JUST SHARED TWO MORE FINDINGS. WE HAVE A LOT OF TEXT DATA SO I JUST LOOKED DOWN AND THEY WERE PURSUE BEING BASIC IMMUNOLOGY OF LUPUS. SO I THINK MOST OF US WOULD CONCLUDE AND AGREE THAT LUPUS IS A WOMEN'S HEALTH ISSUE AND HEALTH DISPARITY ISSUE AND IT'S A 9/1 SEX RATIO. ANOTHER KNOW IN TRIPLE NEGATIVE BREAST CANCER WELL MOST OF US WOULD CONCLUDE THAT'S WOMEN'S HEALTH SO IT MAY HAVE BEEN CONFUSION WITH THE QUESTION OR WE'RE NOT SURE BUT WE WANTED TO LOOK AT THAT FURTHER BECAUSE WE WILL SEE IF THERE'S A SIX DIFFERENCE THERE AND WHAT THEY ARE PURSUING IN TERMS OF THEIR CAREERS. NEXT SLIDE. SO THIS IS SINCERE APPRECIATION AND ACKNOWLEDGMENT, FIRST AND FOREMOST THE SCHOLARS AND THE BIRCH P.I.s FOR HELPING US GET THIS SURVEY DONE. WET LISTINGS BUT NOT UP-TO-DATE E-MAIL AND YOU CAN TRACK SOMEONE DOWN WHO WAS IN A BIRCH PROGRAM IN 2003. IT WAS A LOT OF WORK BY A LOT OF PEOPLE AND WE APPRECIATE THAT VERY MUCH AND WE WANT TO ACKNOWLEDGE THE STRONG AND LONG-TERM SUPPORT OF OUR INSTITUTES AND I JUST PUT THEM IN ORDER HERE. NCI AND THE AGING INSTITUTE AND ALCOHOL INSTITUTE AND ARTHRITIS INSTITUTE AND NICHD AND NIEHS AND THOSE HAVE PARTNER WITH US SOME THE WHOLE TIME AND OTHERS IN AND OUT BUT THEY'VE BEEN HELPFUL TO US ALONG THE WAY. WE WANT A SPECIAL SHOUT OUT TO NICHD WHO HELPED CREATE THE BIRCH PROGRAM IN '99 AND 2000 IN TERMS OF THE WISH MUC WISH MUCH BIRCH PROG RAM AND WE DID HAVE SUPPORT FROM FDA AND I CAN SAY THEY'VE BEEN HEALTH SERVICES FOR PIR MUCH SO THERE'S A NATURAL THERE AND WE HAVE THE TWO CONTRACT FIRMS THAT HAVE HELPED US COMPLETE THE ANALYSIS AND THEY WORKED VERY HARD UNDER A QUICK DEADLINE AND I WANTED TO NOTE BECAUSE WE'RE THE FEDERAL GOVERNMENT THERE'S SPECIAL PRIV' REQUIREMENTS WE DID IT HERE TO THAT IN TERMS OF THE SURVEY AND WITH THAT I CLOSE IT OUT AND I'M HAPPY TO ANSWER ANY QUESTIONS AND CLARIFY ANYTHING AND TO INVITE THE DOCTOR TO JOIN IN AND THE ASSOCIATE DRICK TO BE INFORM CAREER AND THE BIRCH PROGRAM WITH THE CAREER CENTER. THANK YOU, VERY MUCH. >> THANK YOU, AS LISA MENTIONED, THE DOCTOR MENTIONED WE WILL TAKE QUESTIONS RIGHT NOW BUT PLEASE FEEL FREE TO UT CHATBOX AND WHILE WE'RE WAITING FOR YOUR QUESTIONS. >> WE HAVE NOT ANALYZED BETWEEN THAT PROGRAM BECAUSE IT WAS SEPARATE. THERE'S NOT BEEN AN ANALYSIS ACROSS NIH K12 PROGRAM. >> IT'S A LITTLE DIFFICULT WITH THAT. ROGER, ARE YOU OK WITH THAT? DO YOU NEED MORE DETAILS? >> I WOULD BE HAPPY IT TALK WITH HIM FURTHER ABOUT THAT. >> THAT'S GREAT. THANK YOU. >> DR. TEMPLETON IS ASKING A LITTLE BIT MORE. ABOUT THE CAREER TRAJECTORY OF THE BIRCH P.I.s WHETHER WE'RE GOING TO LOOK AT THEIR TRAJECTORY. SHE'S CONCERNED IN MID AND LATE CAREER WOMEN AS A GROUP. >> WE HAVE THE DATA SO YES, WE'RE GOING TO LOOK AT THEM. MANY OF THE P.I.s KNOW HOW MUCH WORK TO SUBMIT A K-12 BUT MANY HAVE PROMOTIONS ACADEMICALLY SO WE HAVE TO LOOK AT THAT IN MORE DEPTH AND A LOT OF THESE RESPONSE WERE TEXT FIELDS BECAUSE WITH ASKED YOUR JOB TITLE SO WE WILL BE HAPPY TO COME BACK IN A FUTURE MEETING AND GIVE YOU MORE IN-DEPTH REPORT. >> DR. KLEIN AS A COMMENT OR QUESTION. DO YOU WANT TO MAKE YOUR COMMENT? ABSOLUTELY. I'M JUST WONDERING IF WE'RE GOING TO COLLECT IN THE DATA PERTAINING TO THE I AM PATH OF COVID-19 ON THESE JUNIOR INVESTIGATORS? AND YOU SHOWED IT'S WOMEN AND WE KNOW OUR JUNIOR INVESTIGATORS ARE BEING EFFECTED. I WONDER IF YOU ARE GOING LOOK INTO THIS? THANK YOU FOR THAT QUESTION. YOU ARE IN THE NEGOTIATED THAT DO YOU WANT TO RESPOND FOR US? OR I CAN. >> IT'S SOMETHING WHICH IS REALLY EMBEDDED IN OUR THOUGHTS THESE DAYS AND KNOWING FULL WELL THE JUNIOR INVESTIGATORS ARE SUFFERING GREATLY FROM THE PANDEMIC AND WE WILL HOPE TO ADDRESS THESE QUESTIONS ALTHOUGH THE CURRENT SITUATION AND HANDS ARE AND HE IS IN A VERY SPOT AND EVERYTHING IS THINKING WE ARE GOING TO DO OUR BEST TO ADDRESS SOME OF THOSE CONCERNS AND WE ARE AWARE OF THIS AS FAR AS BIRCH IS CONCERNED AND I GIVE IT OVER TO LISA AGAIN TO SAY WHAT WE HAVE LEARNED SO FAR. >> SO WE'RE IN THE PROCESS OF PUTTING TOGETHER ACTIVE SCHOLARS SO THEY'RE A PILOT RIGHT NOW WHO HAVE RECEIVED AN INVITATION TO BE PART OF COVID SURVEY FOR EXTRAMURAL RESEARCHERS SO WE HAVE HALF OF THEM THAT HAVE RESPONDED ALREADY AND SO THEY HAVE ANOTHER WAY TO FINISH NORTH RESPONSES AND WE'RE HOPING THAT AT LEAST ON A PILOT BASIS WE'LL HAVE HAVE DATA FOR THE CURRENT SCHOLARS IN TERMS OF COVID-19 AND COVID-19 19 COMPUTATIONS AND BARRIERS. THERE IS A COVID-19 SURVEY GOING OUT TO GRANTEES AND THE THINK POSTED A BLOCK PIECE ABOUT THAT AND SO NIH HAS CONTRIBUTED TO THE DEVELOPMENT OF THAT SURVEY AND SO THERE IS A COVID IMPACT AND I'M EXCITED AS YOU HEARD THAT WE WILL GET DATA FROM THE 66 CURRENT SCHOLARS TO HELP GUIDE OUR NEXT STEPS AND IT'S CHALLENGING BUT WE ARE INTERESTED IN UNDERSTANDING HOW IT MIGHT HAVE AN IMPACT ON WOMEN AND ALSO ON THOSE RIGHT AT THE CUSP OF THE TRANSITION LIKE THE BIRCH SCHOLARS AND TO SUPPORT THEM. AS YOU CAN IMAGINE IT'S ACROSS THE BOARD ISSUE AND WE NEED STRATEGIES IF POSSIBLE. LET'S SEE, LISA. THERE'S OTHER OTHER POINTS THAT ARE BEING MADE. I'M NOT SEEING ANY NEW QUESTIONS OR COMMENTS. >> I WOULD BE HAPPY TO TAKE E-MAILS, PHONE CALLS AND PARTICULARLY WITH OUR ADVISERS, WORK WITH YOU AS WE MOVE FORWARD. >> SO THANK YOU. >> THANK YOU. >> I WANT TO THANK DR. BEGG FOR HER LEADERSHIP OF THE BIRCH PROGRAM FOR MANY YEARS NOW AND AS WE'VE MOVED INTO BEING ABLE TO ASSESS IT AND UNDERSTAND WHAT IS WORKING AND STREAMLINE AND IMPROVE THE PROGRAM OVERTIME, LISA IS IN THIS 20th ANNIVERSARY YEAR OF THE BIRCH IT'S EXCITING TO SHOW THAT IMPACT SO I APPRECIATE ALL OF YOUR EFFORTS SPECIFICALLY. SO WE'RE IN OUR OPEN DISCUSSION SESSION TO BRING TO ATTENTION ISSUES THAT YOU SHOULD BE AWARE OF AND POINTS YOU MIGHT WANT TO BE DISCUSSED TODAY AND THINGS YOU WANT TO HEAR ABOUT AT A FUTURE MEETING OR ANYTHING AT ALL THAT YOU WANT TO SHARE IN TERMS OF ADVICE IN COUNCIL EX IN YOUR ROLE AS ADVISORY COMMITTEE MEMBER SO THIS IS AN OPPORTUNITY FOR THAT OPEN DISCUSSION. YOU ARE ON VIDEO. ARE YOU TRYING TO MAKE A COMMENT? >> I WAS COMING TO SAY HELLO OVER TO. I KNOW WE'VE DONE IT IN THE PAST TO LOOK AT WOMEN OF COLOR BUT I FEEL LIKE IT'S MORE IMPORTANT. THE BLACK LIVES MATTER MOVEMENT IS SO IMPORTANT TO EVERYBODY'S STRESS LEVEL AND HEALTH BUT COULDN'T WE HAVE EVEN MORE A PROGRAM THAT OWNS ON ALL THE DIFFERENT RACE ETHNIC GROUPS AND ASIANS AND LOOKING AT THINGS IN A MORE INTER SECTIONAL FRAMEWORK. >> ARE YOU THINKING ABOUT FROM A CAREER STANDPOINT? >> NO, NO. >> I WAS TALKING ABOUT HOW CAREER AS WELL. PEOPLE ARE VERY STRESSED AND IT CROSSES THE WHOLE SPECTRUM OF CAREER AND JUST THE HEALTH ISSUES IN GENERAL. >> ABSOLUTELY. DR. HOOPER HIGHLIGHTED THAT IN HER REMARKS THE DIFFERENTIAL IMPACT AND DISPROPORTIONATE BURDEN WE SEE IN UNDER REPRESENTED MINORITY COMMUNITIES. SHE HIGHLIGHTED A FEW AND I CAN'T REMEMBER IF IT WAS HER SLIDES THAT HAD 8 TO 12 TIMES OF GREATER RATE AND IN NEW YORK CITY AND I KNOW THROW TO FOUR TIMES IS THE NATIONAL DATA AND TO HEAR EIGHT TO 12 TIMES IN NEW YORK CITY REALLY WOOS JOLTING AND AS YOU HEARD FROM THE SPEAKERS, BEING A CANARY IN A COAL MINE, I THINK THE HEALTH DISPARITIES ARE VERY CLEAR AND WE ARE HEARING FROM YOU ARE THOUGHTS ABOUT BEING ABLE TO DISSECT THAT FURTHER AND LOOK AT EVEN MORE GRANULAR LEVEL AND PERHAPS AS AN INCREASED AREA AND IS THAT RIGHT? >> JUDY, DO YOU WANT TO MAKE A COMMENT? >> I BELIEVE THE DOCTOR -- IT'S UNBEARABLE TO THINK OF PEOPLE BEING TREATED SO DIFFERENTLY AND SO WRONGLY AND NOT BEING INCLUDE AND I DON'T WANT TO FORGET WOMEN OF HALF THE POPULATION AND HOW THE HEALTH OF WOMEN IS STILL VERY UNDER STUDIED AND I WANT TO KEEP BOTH FOCUSES ALIVE BECAUSE I STILL LOOK AT THE LITERATURE SAYING NOW, SURELY WE'VE CAUGHT UP AND I SEE WE HAVE NOT CAUGHT UP AND THERE ARE MANY ANSWERS WE STILL NEED TO GAIN SO WE HAVE TO LOCK AT INTERSECTION SECTIONALITY AND ALL WOMEN STILL DO NOT HAVE APPROPRIATE HEALTHCARE. SO NOTED. OTHER COMMENTS. >> DR. GELLER. >> HERE I GO. TAKES A SECOND TO UNMUTE AND DO THE VIDEO. I'D LIKE TO AGREE THAT WE DO A DEEPER DIVE AND I WOULD ALSO LIKE TO NOT TALK WE ALL GET WHAT THE PROBLEM IS AND WHAT WE SEE IN SYSTEMIC RACISM I'D LIKE TO HEAR FROM PEOPLE SOME OF THE THINGS THAT THEY'RE DOING TO ADDRESS IT AND WE ALL FEEL TERRIBLE BUT YOU KNOW THAT AND TWO BUCKS WILL GET YOU ON THE BUS. I'D LIKE TO TALK ABOUT WHAT WE'RE DOING. I COULD SHARE ABOUT WHAT I'M DOING AROUND CAREER HELPING JUNIOR FACULTY AROUND MENTORING AND CAREER ISSUES THAT THEY'RE HAVING NOW. WE'RE JUST HAVING LITTLE WORKING GROUPS AND WE WORK TOGETHER AND HAVE DIVERSE GROUPS SO THAT'S WHAT I'D LIKE TO HEAR AND I'M SOUR EVERYBODY ON THE ADVISORY BOARD IS DOING SOMETHING AND THAT WOULD HELP ME AND I THINK WE ALL HAVE A LOT TO SHARE WITH EACH OTHER. BEFORE WE GO, WE'LL GIVE AN OPPORTUNITY FOR ANYBODY TO SHARE STEPS THAT THEY'VE TAKEN TO ADDRESS THESE ISSUES INFORMALLY OR FORMALLY AND I WOULD GIVE ANNA A CHANCE TO MAKE HER COMMENT BEFORE WE DO THAT AND MAYBE GO AROUND THE ROOM ON THE LIST HERE AND TO GET THE FOLKS WHO HAVEN'T HAD A CHANCE TO MAKE A COMMENT TO WEIGH IN ON THAT OR ANYTHING WE'VE PRESENTED OR ANYTHING ELSE YOU'D LIKE TO COMMENT ON. >> YES, THANK YOU. IT'S SOMEHOW DIFFICULT TO FIND A POSITIVE SIDE TO THE TERRIBLE SITUATION WE'RE ALL IN AND DURING THE MEETING TODAY, THERE ARE SOME THINGS THAT MADE ME THINK THAT SOME THINGS WERE SAID THAT MADE WE THINK ABOUT PUSHING OUR SHARED AGENDA AND WE HAVE HEARD MANY TIMES, COVID-19 IS A MAGNIFIER OF EVERYTHING SO ALL THE EQUITY GAPS AMONG SOCIAL ETHNIC AND RACIAL GROUPS AND THE NEED FOR EQUALITY AND ALSO THE IMPORTANCE OF SEX AND GENDER THAT IS OFFICE WHAT THE DOCTOR SAID ABOUT THE EVIDENCE WE HAVE ABOUT HOW IMPORTANT IT IS THAT THE RANGE HE CALLED IT WHY BARRIO LAND WHICH IS SOMETHING WE'VE BEEN TRY TO HIDE THAT FOR SO LONG AND I WONDER WHAT WE COULD DO AS A GROUP AND YOU IN PARTICULAR THE RESEARCH AND WOMEN'S HEALTH AND TO USE THE MOMENTUM AND I THINK IT LINKS WELL WITH STACEY JUST SAID AND WE ARE DOING A NUMBER OF THINGS AND MAYBE WE CAN DO MUCH MORE. IT'S HARD TO POINT TO A POSITIVE. WE REALIZE THAT SCIENCE IS NEEDED MORE THAN EVER AND THE HEALTH OF WOMEN ARE DEPENDING -- WOMEN DEPEND ON US TO FIND A WAY THROUGH THE PANDEMIC, WHICH I'M CALLING IT A COLLISION OF CRISIS AND IT IS THERE ARE SO MANY CRISIS UNDERLYING AND MAYBE THEY WERE THERE BEFORE BUT THEY MAY BE MORE EVIDENT TO SOME WHO ARE NOT AWARE OF THEM AND SO HOW CAN WE SPUR INNOVATION. YOU HEARD FROM BRUCE ABOUT INNOVATION MAKING PEOPLE DO THINGS DIFFERENTLY AND NECESSITY IS THE MOTHER OF INVENTION, RIGHT. THOSE KINDS OF ISSUES BUT AGAIN, UNDER THE CURRENT CIRCUMSTANCES WHERE BUDGETS ARE THE SAME FOR ORWH AND WE HAVE A GLOBAL PANDEMIC. WE HAVE MANY INDIVIDUALS THAT ARE WORK ONG A LOT OF PIECES OF THE PUZZLE AND YOU HEARD FROM HELEN ABOUT THE IMPORTANCE OF INTEGRATION WHICH IS VERY MUCH ALIGNED WITH THE ORWH PERSPECTIVE IN THE FRAMEWORK CONTEXT THAT WE AND THE HEALING SPAN WE OPERATE ON BUT IT'S NOT THE WAY MOST OF OUR STRUCTURES ARE ORGANIZED OR SPECIALIZED AND FRAGMENTED IN THAT WAY. I WOULD LOVE TO HEAR THE BRAINSTORMING ABOUT IDEAS IN RESPONSE TO TASE''S CHALLENGE TO SUPPORT AND WHAT IDEAS TO YOU HAVE GOING FORWARD. >> SO, JUST TO TALK ABOUT WHAT WE'VE DONE AND I'LL RAMBLE HERE BUT ONE OF THE SILVER LININGS AT ALL AS FAR AS I'M CONCERNED AND NEVERTHELESS, ONE OF THE THINGS THAT WE'VE BEEN FORCED TO THINK ABOUT IT AND THE EYE OPENING DAY TOWARDS THE SOCIOECONOMIC IMPACT AND OF COURSE IT OPENED OUR EYES TO WOMEN. I CAN'T SAY THERE HASN'T BEEN MORE IMPACT AND FOCUS ON JUST SOCIOECONOMIC UNDER REPRESENTED MINORITY GROUPS VERSUS WOMEN AND WHO ARE WITHIN THOSE GROUPS BUT NEVERTHELESS IT CAN BE A WIN-WIN TO JUST BE MORE FOCUSED ON IT FROM A DEPARTMENT LEVEL, FOR EXAMPLE, WE'VE BEEN HAVING RETREATS WHERE THEY ARE FRONT AND CENTER AND JUST TALKING ABOUT AN EFFORT FOR WELLNESS AND OUR STAFF VERSUS SOME OF THE DOCTORS AND ARE GOING THROUGH HAVE BEEN EYE OPENING AND IT'S A FIRST START AND IT'S AN INSTITUTIONAL LEVEL AND WHAT WE HAVE DONE WITH RESPECT TO SCIENCE IN THE DEPARTMENT IS WE'RE PLANNING A NEW RETREAT JUST FOR SCIENTISTS AND WE'RE GOING TO GET EVERYBODY BEHIND AND GETTING INTO THE HIGH SCHOOLS, FOR EXAMPLE, AND GETTING BACK EARLIER BE JUST DEVELOPING GROUPS TO SUPPORT UNDER REPRESENTED MINORITY WHO ARE CURRENTLY IN THE SYSTEM BUT REALLY FINDING WAYS TO OPEN THE PIPELINE IN THE COMMUNITY MORE FOR OUR UNDER REPRESENTED MINOR FEES AND THAT'S A BIG FOCUS ON WOMEN AND STEM TO AND GET MENTORING SUPPORT AND HOLDING HANDS FROM HIGH SCHOOL THROUGH UNTIL THEY GET TO MEDICAL SCHOOL OR THEIR PHD AND WE WERE STARTING A NEW PROGRAM FOR WOMEN WITH UNDER REPRESENTED WOMEN AND THERE'S BEEN NO PARTICULAR SUPPORT WHATSOEVER FOR THAT ONE DEMOGRAPHIC WITHIN THE INSTITUTION AND IT WILL HELP PEOPLE WHO ARE NOT IN ANY OTHER SUPPORT STRUCTURE. >> THANK YOU, AMY, THAT'S REALLY HELPFUL. OTHERS? ANY COMMENTS FROM YOU? >> I THINK YOU ARE MUTED AND WE CAN'T HEAR YOU. WE STILL CAN'T HEAR YOU. I WAS HOPING YOU COULD OFFER FROM A DENTAL PERSPECTIVE. SHALL WE COME BACK TO YOU IN A MINUTE. WE CAN'T HEAR YOU. WHICH STILL CAN'T HEAR YOU. YOU HAD A COMMENT AND I WASN'T ABLE TO TAKE AT THE END OF THE PANEL AND LET'S GO TO FOR ROGER FIRST AND A GOOD DEAL. THANK YOU, ROGER. IN TERMS OF WHAT WE'VE BEEN DOING DURING THE PANDEMIC. WE STARTED A WEEKLY MEETING OF OUR GROUP POST DOCUMENTS AND EARLY STAGE FACULTY MEMBERS AND TO ENCOURAGE PEOPLE ON PRODUCTIVITY AND MAINTAINING SOME CONNECTIONS AND PEOPLE HAVE, IT'S BEEN BRIEF IT WAS HELPFUL AND WHAT WE RECENTLY DID WITH THAT GROUP IS DID A ROUND-ROBIN WHERE TWO OR THREE PEOPLE EACH WEEK WOULD PRESENT THE BEST THINGS THAT HAVE HAPPENED DURING THE PANDEMIC SO HIGHLIGHTING BOTH SORT OF WORK RELATED ACCOMPLISHMENTS AND SOMETIMES WE FORGET ABOUT BUT ALSO, BENEFITS FOR EXAMPLE OF BEING AT HOME AND SPENDING TIME WITH THE KIDS MIGHT OCCUR AND IT'S REALLY BEEN DONE AND REMINDED US THAT IT HASN'T BEEN ALL BAD AND WE'VE MAINTAINED PRODUCTIVITY AND THERE'S BEEN BENEFITS AS WELL AS COST DURING THE PANDEMIC AND SO THAT IS A VALUABLE ACTIVITY FOR US. >> THANK YOU FOR SHARING THAT. >> THANK YOU, JEANNINE. WITH REGARD TO THE BIG QUESTION THAT IS DISCUSSED HERE, IT HAS BEEN IMPORTANT FOR US AS A SCIENTIFIC COMMUNITY TO REACH OUT TO THOSE THAT ARE MORE EFFECTED BY THE CURRENT CRISIS AND TO REACH OUT TO ENTITIES WITHIN THE PITTSBURGH COMMUNITY INCLUDING WE REACHED OUT INFORM HIGH SCHOOLS TO CAREER COUNCILORS AND SCIENCE TEACHERS AND ENGAGE THEM AS MUCH AS WE CAN AND ALL OF OUR ACTIVITIES INCLUDING A BIG ONE WE'RE PREPARING FOR MAY OF NEXT YEAR SO WE'RE DOING ALL WE CAN AND RESEARCH INSTITUTE TO SCIENCE AND PROMOTE KNOWLEDGE AND REACH OUT TO COMMUNITIES THAT ARE HIGHLY EFFECTED BY CURRENT CIVIL CRISIS. THE OTHER COMMENT IS RELATED TO NL SHAH'S PRESENTATION. ONE IS THE QUESTION OF CONTROVERSIAL AND THE PAPER THAT WAS CITED IN CLOSE ONE DID NOT REFLECT THE COMMON THEME TO BASED ON THE SEQUENCING OF ALL THE DATA BUT IT'S TRUE THAT THE PROCESSING PROTEINS ARE AND HE ISED IN THE MUCH LOWER LEVEL AND IS ALSO NOTED MUCH LOWER LEVEL AND IN THE LAST COMMENT WHICH WAS VERY INTERESTING YOU MENTIONED THAT THERE WAS HIGHER INCIDENTS OF PRO TERM BIRTHS IN COVID-19 DISEASE AND IT WAS JUST A PAPER THAT CAME OUT A WEEK AGO FROM THE NETHERLANDS AND SHOVING THERE WAS A REDUCTION SINCE THE CRISIS STARTED AND THIS WAS CITED TWO DAYS AGO IN THE "NEW YORK TIMES" AND IT WAS INTRIGUING AND THE PROBLEM WITH IS THIS AND REFLECTS, DOES NOT REFLECT PRE TERM BIRTHS AND WERE WOMEN HAD LESS ACCESS TO DOCTORS THERE MIGHT HAVE BEEN LESS INDUCTION AND LESS PRE DETERMINE DELIVERIES WITH THESE AND THIS WAS NOT ABLE WITH THE DIFFERENCES AND THIS IS A KEY ISSUE BECAUSE IF WE SEE A REDUCTION, THE COST MAY BE AN INCREASE IN OTHER ADVERSE OUTCOMES THAT COULD HAVE BEEN PREVENT BID AN INDUCTION OF LABOR SO I WANT TO CLARIFY THOSE POINTS AND THANK YOU. ALL OF THAT HAS TO BE TAKEN INTO CONSIDERATION AND I SEE DR. ROBINSON WAS ABLE TO MAKE A COMMENT AND THE CHAT AND SHE SHARED THAT THEY ARE MENTAL HEALTH AND FOCUSED ON WOMEN AND PEOPLE OF COLOR AND NEGATIVELY IMPACTED BY THE ISOLATION RESULTING FROM THE PANDEMIC AND SO THANK YOU MICHELLE FOR PROVIDING THAT CONTEXT AND DR. REAGANSTEINER TO THE UNIVERSITY OF COLORADO SCHOOL OF MEDICINE WILL PLAN FOR A MAJOR CENTER OF HEALTH EQUITY AND SHE WAS SHE'S EXCITE TODAY SEE THAT MOVING FORWARD DESPITE THE CHALLENGING CONTEXT WE'RE IN AND I DO WANT TO DR. DR. JAGSEE. YOU HAVE KA ROAR DEVELOPMENT AND PROGRESSION OF WOMEN AND SPECIFICALLY IN MEDICINE AND IN TENSES OF WOMEN AND RELATE TODAY OTHER OBSTACLES AND I WOULD LOVE TO HEAR YOUR THOUGHTS ON THE CURRENT CIRCUMSTANCES IN SUPPORTING WOMEN MID CAREER AND WOMEN IN SCIENCE AND BIO MEDICINE WHO WE HAVE BEEN CONCERNED ABOUT FOR THEM TOO AND WE DID HEAR THE CONCERN AND THERE'S VALID CONCERN FOR MOST DOCUMENTS AND FELLOWS BUT I WANT TO HEAR YOUR THOUGHTS ON WHAT STRATEGIES WE MIGHT BE ABLE TO EMPLOY TO HAVE A TARGETED INTERVENTION. OF COURSE WE WOULD LIKE TO HAVE MORE RESOURCES TO DO MORE BUT I WANT TO UNDERSTAND WHAT A TARGETED INTERVENTION MIGHT LOOK LIKE. IT WAS AN PROCEDURE NOT FOR THOSE MID-YEAR AND WE KNOW TO BE VULNERABLE AND I THINK THE MECHANISMS ARE IT'S THE SAME THINGS WE'VE TALKED ABOUT FOR MANY YEARS SO THE UNCONSCIOUS BIAS AND THEY'RE PLAYING OUT IN A REMARKABLE VARIETY OF WAYS AS WHICH TRANSITION TO COMMUNICATING ON VIRTUAL PLATFORMS AND I WAS JUST IN A VERY LARGE MEETING AND IT WAS SHOWING UP IN THE WAYS THAT PEOPLE USE THE CHAT FEATURE TO UNDERMINE SPEAKERS SO WHEN YOU ARE SPEAKING, YOU ARE NOT ABLE TO READ AND MONITOR THE Q&A AND THE CHAT AND I WAS TOLD, CONGRATULATIONS BECAUSE IT WAS BENIGN BUT DID YOU SEE WHAT HAPPENED TO YOUR COLLEAGUES AND I WAS IT WAS NOTICE CALLED OLD THERE WERE REALLY AND MICRO AGGRESSIONS AND OCCURRING VIA THE CHAT WHERE VIEW POINTS ARE BEING DIS MESS MISSED AND OPENLY AND VERY DIFFERENT FROM WHAT WOULD HAPPEN AND CONTEXT AND I THINK THOSE ARE THE THINGS YOU UNDERSTAND AND HOW ARE LEADERSHIP AND WHAT WHAT WE HAVE OUR FIGHT OR FLIGHT AND THE TAKES ARE REALLY HIGH AND WE NEED LEADERS CAPABLE SO WE TURN TO PEOPLE WE KNOW WE CAN TRUST AND THOSE PEOPLE HAVE CERTAIN CHARACTERISTICS AND THEY NATURALLY GRAVITATE TO PEOPLE WHO ARE LIKE THEM SO I SEE ALL THE ACTIVATION OF THOSE MECHANISMS THAT WE'VE KNOWN FOR A LONG TIME AND WOMEN ARE MORE LIKELY TO BE EXTRA PROFESSIONAL CAREGIVERS SO THOSE WITH CARE THEY ARE TARGETING THE SAME MECHANISMS THAT WE'VE KNOWN ABOUT IDENTIFIED IN THE PROMISING PRACTICES REPORT THAT YOU DISCUSSED AND OTHER PLACES WE KNOW AND SOME OF THOSE MECHANISMS ARE TAKING NEW FORMS AND WE NEED MORE RESEARCH TO IDENTIFIED THE LIVED EXPERIENCES OF BOTH YOUNG AND MID CAREER AND SENIOR CAREER WOMEN AND THOSE WHO YOU BROUGHT UP IN MANY PEOPLE IN THIS GROUP HAVE BROUGHT UP INHABIT MULTIPLE INTERSECTIONAL MARGINALIZED IDENTITIES AND HO THEY'RE PLAYING OUT IN THE CONTEXT OF THIS PANDEMIC AND RAISED AWARENESS OF SYSTEMS IN OUR SOCIETY SO WE HAVE A LOT OF WORK AHEAD OF US AND CUT OUT FOR US BUT WE CAN ROW LION WHAT WE KNOW ABOUT THE BROAD MECHANISMS AND CHALLENGES AND GO FROM THERE. >>. PRY TISH AND IT'S IT ROW MINDS ME OF THING STHEY ARE POSTING THEY WOULD NEVER SAY TO SOMEONE IN-PERSON. WE HAVE TO TYPE EVERYTHING AND WRITE EVERYTHING BECAUSE YOU KNOW, IT'S VERY DIFFERENT AND TO HEAR FROM YOU AND THE BRAIN TOMORROWING AND THE CAMARADERIE AND THE INNOVATION THAT'S COMES FROM THAT AND THAT IS NEED TO BE MODELED AND WE NEED TO STUDY THAT SO WE CAN UNDERSTAND FOR RESEARCH TEAM AND CAN'T DO THAT EITHER. SO THANK YOU FOR YOUR THOUGHTS THERE AND I WILL SHARE WITH YOU THAT THE WORKING GROUP ON WOMEN AND I CO-CHAIR AND KEY RECENTLY VISITED AT OUR SEPTEMBER MEETING AND CHARGED THAT GROUP WITH THINKING ABOUT BEING DISRUPTIVE IN THE SPACE OF THE CONTEXT OF COVID-19 PANDEMIC AND IT'S CONSEQUENCES ON WOMEN AND OTHER OTHER REPRESENTED GROUPS AND WHAT WE MIGHT DO SO WE ARE CONSIDERING THE PROMISING PRACTICES REPORT AND THE ACD WORKING GROUP REPORT ON ADDRESSING THE CULTURE TO END SEXUAL HARASSMENT TO TRY TO IDENTIFY A FEW AREAS TO FOCUS ON GOING FORWARD AND SO SUGGESTIONS ARE THOUGHTS ARE TIMELY SO THANK YOU VERY MUCH FOR THAT AND I APPRECIATE IT. THE IMPACT OF ALL THESE MEETINGS BY WHOM OR DIFFERENT CISCO WEBEX OR WHATEVER IT MIGHT BE AND IN OUR BOARD MEETINGS WHERE THEY'RE VERY FEW WOMEN AND IN-PERSON WOMEN GET MARGINALIZED OR HOW MANY OF US ARE IN ROMS WHERE WE SAY SOMETHING AND TWO MINUTES LATER SOMEONE ELSE SAYS THE SAME THING AND IT'S LOOKED AT IN A DIFFERENT WAY SO I HAVE NOT SEEN ANY RESEARCH ON THIS AND I THINK AS WE'RE DOING LAB MIGHTINGS OR DEPARTMENT MEETINGS OR WHATEVER WE'RE DOING, PEOPLE WHO ARE MORE QUIET GET MORE COMFORTABLE PUTTING IN COMMENTS ON THE CHAT SO IT'S SOMETHING THAT I HAVEN'T NOTICED BUT I'M GOING TO LOOK FOR THAT NOW BUT HIGHWAY DOES IT HAVE IN THE OTHER WAY HELPED EQUALIZE THE COMMENTS THAT PEOPLE ARE ACTUALLY READING OR HEARING AND I DON'T KNOW THE ANSWER. THANK YOU FOR POINT TAG OUT AND THERE'S A WELCOME FOR RECORDED MEETINGS THAT COULD BE VEIL WAITED AND THE POINT IS WE DON'T HAVE THE DATA AND SO THAT MEANS WE NEED TO STUDY THAT AND SEE TO YOUR POINT, SOMEONE ELSE SAID TO ME THE OTHER DAY THAT IT HAS ALLOWED SOME PEOPLE TO JOIN THE MEETING WITH WOULD HAVE NEVER BEEN ABLE TO COME TO THE MEETING MEETING. ON BOTH SIDES THERE'S BENEFIT AND OF COURSE DETRACTION FROM THAT AND WE DO HAVE A CHOICE WE'RE IN THE SITUATION AND WE'RE TRY TO DO OUR BEST TO BUILD UPON IT BUT TO UNDERSTAND ITS IMPACT AND DO YOU WANT TO MAKE YOUR COMMENT ABOUT COVID-19 IMPACTS AND HOW WE CAN LOOK AT THAT. >> ABSOLUTELY. THANK YOU, JEANNINE. ONE OF THE THINGS THAT WORE DEBATING AT OUR INSTITUTION AND ALL IPSOS-REID TUESDAYS REPRESENTED ON THIS BOARD ARE LIKELY DOING THE SAME AND IS JUNIOR FACULTY OF THE IMPACT OF AND YOU KNOW, I'VE SEEN A LOT ON SOCIAL MEDIA AND PERTAINING TO THIS BUT THIS MIGHT BE AN OPPORTUNITY FOR ORWH TO TAKE A LEAD AND MAYBE BOTH SIMPLIFYING BECAUSE SOME OF WHAT I'VE SEEN ARE COMPLEX AND GIVING SOME GUIDANCE THAT MIGHT EVEN FORM HOW AND FOR NIH. BECAUSE, I KNOW THAT IT HAS BEEN DISCUSSED AND I HAVE RARELY SEEN IT AND AS A REVIEW IF YOU HAD TO TAKE AND FOR CHILDBIRTH AND CHILDCARE AND MAYBE AND YOU CAN ACCOUNT FOR IT IN YOUR BIO SKETCH AS MAYBE AN EXPLANATION FOR REDUCES ONCE AND ONE OF THE THINGS THAT HAS BEEN SAID TO ME I WASN'T OF GENERATION AND JUST STAY QUIET AND BUT MOST YOUNGER PEOPLE DON'T WANT THIS INFORMATION ON THERE FOR FEAR IT MIGHT ACTUALLY HURT THEM AND WE ARE HAVING DEBATES WHERE PEOPLE THAT ARE FULL PROFESSORS WITH TENURE AND HAVE GRANTS AND ARE SAYING OH, DO THIS AND THE JUNIOR PEOPLE ARE SAYING I DON'T ACTUALLY WANT TO DO THIS AND STOPPING THE 10-YEAR CLOCK. GO TALK TO PEOPLE AND THEY'RE AFRAID TO ADMIT AND THEY TRULY, MANY, I DON'T KNOW THAT ALL THIS IS ALL INFORMAL, ARE CONCERNED THAT IT MIGHT HURT THEM DOWN THE ROAD SO I DON'T KNOW. NIH COULD TAKE A LEADERSHIP ROLE AND MAYBE THE OFFICE COULD BE HELPING TO COORDINATE AND LEAD SOME OF THOSE EFFORTS AND I DON'T THINK THERE'S A GOOD SIN SYNTHESIS. WE'VE TALKED ABOUT IT IN THE WORKING GROUP AND I REALLY APPRECIATE YOUR COMMENTS AND WE HEARD OVER AND OVER, AND WE WORKED HARD TO MAKE THAT SPACE IN THE BIO SKETCH THAT PEOPLE COULD USE IT. IF THEY DON'T FEEL COMFORTABLE IT'S A CULTURE IN CLIMATE ISSUE AND WE NEED TO PARTNER WITH INSTITUTIONS AND I MEAN, THERE'S ONLY SO MUCH NIH CAN DO RIGHT SO WE NEED TO PARTNER WITH YOU TO SAY HOW CAN WE CHANGE THIS CULTURE AND CLIMATE SO THE EXPECTATIONS ISN'T THAT THAT IS A NEGATIVE AND YOU CAN MEASURE CULTURE AND CLIMATE AND THERE ARE INSTRUMENTS FOR THAT BUT WHAT'S THE INTERVENTION THAT WOULD CHANGE ATTITUDES ABOUT THAT AND AGAIN WE KEEP SAYING IF THERE ARE MORE WOMEN LEADERS HOW CAN WE H HE CAN SELL RATE ACCELERATE THIS PROGRESS. I KNOW THERE ARE AMAZING, CREATIVE PEOPLE OUT THERE ON THIS GROUP. STACEY WANTS TO MAKE A COMMENT TOO. THAT IS SOMETHING THAT WE WANT TO HEAR FROM YOU. WE'RE ALLOWING AND WE'RE SIMULTANEOUS TRAINING TO OUR PNT COMMITTEEs ACROSS THE THEN PEOPLE ARE SCARED AND THE SAME THING YOU DIDN'T TAKE A ROLL BACK FOR THE BIRTH OF A CHILD IT WAS A VERY NEGATIVE THING AND NOW IT'S FAR MORE ACCEPTABLE BECAUSE STRIDE TO MAKE IT FAMILY LEAVE SO IF YOU DO THIS AT YOUR INSTITUTION THE TRAINING AND THE CHANGE IN CULTURE HAS TO GO HAND AND HAND. >> I SAW THE COMMUNITY ABOUT PAUSING AND THE TRACK AND HOW THIS MIGHT BE EFFECTING SURGEONS AND. >> HAVING THAN PEOPLE ASKING FOR THAT AND I WORRY WOMEN IN PARTICULAR WOULD FEEL AS THOUGH THEY ARE INTIMIDATED MAKE IT ACROSS THE BOARD FOR EVERYONE. >> GOT IT. IT'S JUST FOR EVERYBODY AND YOU DON'T HAVE TO WORRY ABOUT IT IF YOUR CULTURE HAS THE CHANGED YOU DON'T NEED TO HOPE WE KNOW THEY'RE LESS LIKELY TO BE PROMOTED WITH THE SAME CREDIT CREDENTIALS IN TERMS OF SURGERY, IT HAS HAD IMPACT ON SURGERY, ELECTIVE SURGERY SO IT'S LED TO WE DELEGATE THEM TO DOING RESEARCH SO THEY'RE ACCOMPLISHING SOMETHING DURING THIS PERIOD OF TIME EVEN IF THEY DON'T HAVE AN BOOZE OF RESIDENTS BEING SPLIT UP INTO TWO OR THREE RESIDENTS YOU ARE IN A MEGA TEAM WITH MAYBE 10 OR 15 RESIDENTS AND THAT HAS ALLOWED COLLABORATION AND THEY TEND TO HAVE EACH OTHER'S BACKS A LITTLE BIT MORE. THANK YOU FOR SHARING THAT KIM AND AMY IS ASKING SAYING THAT THE EXTENSION WAS THEY GAVE THEIR FACULTY AND ONE YEAR EXTENSION AND AS YOU SUGGESTED, KIM AND I'M AWARE OF MANY PLACES THEY HAVE TO ASK AND IT SOUNDS LIKE YOU HAVE TO ASK AND THIS IS VERY ARY ABLE AND I DO HEAR ALL OF YOU SAYING THEY HAVE A ROLL TO PLAY IN OUR EXPECTATIONS FOR PRODUCTIVITY, GRANT PRODUCTIVITY AND WE NEED TO BE CLEAR AND WE COULD PARTNER MORE EFFECTIVELY WITH YOU, PERHAPS WE NEED TO HOLD HANDS WITH THE INSTITUTIONS EXPECTATIONS OF PRODUCTIVITY AND OUR EXPECTATIONS BECAUSE THIS IS BEING DISCUSSED AT THE HIGHEST LEV AND WORE TRYING TO PUT IN PLACE EVERY FLEXIBILITY AVAILABLE TO US TO SUPPORT INVESTIGATORS ALONG THE WAY HERE AND SOME HAVE PUT IN PLACE SOME COST EXTENSIONS FOR EXAMPLE SO CAN YOU WEIGH IN ON WHAT IS GOING ON AT WASH YOU? >> I'D FICK LICE TO WEIGH IN ON THE COMMENTS ABOUT DIRECTIONS OF ORWH. I WANT TO THANK YOU FOR EVERYTHING YOU ARE DOING. IT'S AN AMAZING TEAM AND IT'S BEEN AN AMAZING TEAM DOING SUCH IMPORTANT WORK AND I'M SO DELIGHTED TO SEE YOU TAKE SUCH A LEADING ROLE IN THIS COVID-19 PANDEMIC AND INFECTIOUS DISEASE IS IMPORTANT ISSUE FOR WOMEN'S HEALTH AND IN TERMS OF ADVICE THIS IS A GOOD REMINDER WE SHOULD LOOK AHEAD FOR THE NEXT CRISIS AND THE NEXT PANDEMIC AND THE THING THAT IS RIGHT AROUND THE CORNER, IS ANTIBIOTIC RESISTANCE AND IT'S REACHING A TIPPING POINT AND THEY ARE GETTING HARDER AND HASHEDDER TO TREAT AND BEING PREDICTED BY A NUMBER OF AGENCIES THIS IS GOING TO BE A CRISIS SO IT'S SOMETHING TO KEEP TON THE RADAR I THINK FOR THIS PROPORTIONATELY WOMEN AND JUST LIKE COVID AND EVEN THOUGH WE'RE IN THE MIDDLE OF THIS PANDEMIC IT'S GOOD TO KEEP LOOKING AHEAD AND AS FAR AS WASHU, WE HAVE IN TERMS, PROGRAMS TO EXTEND 10 YEAR FOR WOMEN AND UNDERGOING GIVE PROBLEMS AND SO FOURTH SO IT'S A GOOD PROGRAM SO THEY GET A CERTAIN AMOUNT OF TIME OFF AND IT DOESN'T COUND AGAINST THE 10 YEAR CLOCK SO WE'RE BEING PROACTIVE. >> IN OUR LAST THREE MINUTES WE'LL JUST OPEN IT UP FOR ANYONE THANK YOU WHO HAS WEIGHED IN A LOT OF THE CAREER ISSUES AND FROM A SCIENTIFIC PERSPECTIVE AND SO SCOTT LET US OFF WITH HIGHLIGHTING THE NEED FOR US TO BE INDIVIDUAL ANT ABOUT THE ISSUES OF ANTI-BE ANTIBIOTIC RESISTANCE AND WE ALWAYS NEED TO DO MORE AND OF COURSE INTEGRATE SEX AS A BIOLOGICAL VARIABLE INTO THAT AND OTHER TOPICS THAT YOU THINK SHOULD BE ON OUR RADAR SCREEN TO PRIORITIZE. WE KEPT YOU ALL DAY AND MAYBE YOU ARE TIRED. NO WORRIES. SO OF COURSE THE CHAT, CAN YOU FEEL FREE TO PUT INFORMATION THERE AND GIVEN THAT I HEARD FRANCIS COLLINS AND PIERRE THIS MORNING AND THE VACCINES AND I'M WONDERING, I THINK THAT POINT RAISED EARLIER ON ABOUT VACCINE AND UPTAKE ON OUT INTO THE COMMUNITY, ESPECIALLY COMMUNITIES OF COLOR AFRICAN AMERICAN AND I REALLY THINK THAT FOCUSED ON WOMEN AND WOMEN DO A LOT OF TAKING CARE OF THE HOUSEHOLD AND MAKING SURE PEOPLE GET VACCINATED AND GET TO THE DOCTOR. IT'S REALLY IMPORTANT IN THE NEXT COMING MONTHS. ANNA AND THEN SCOTT. >> I THOUGHT YOU WANTED TO MAKE A COMMENT BECAUSE YOU TURNED YOUR CAMERAS ON. >> NO WORRIES. I WANT TO BE READY. >> SCOTT. I WANT TO CONGRATULATE OUR TWO FEMALE NOBEL PRIZE WINNERS THIS YEAR AND IT'S OUTSTANDING. WE ARE AT 4:00 AND THE DOCTOR ARE THERE ANY CLOSING REMARKS THAT YOU'D LIKE TO MAKE? >> I LIKE LIKE TO THANK EVERYBODY FOR SUCH A GREAT MEETING. BETWEEN NOW AND NOVEMBER 2nd NOVEMBER 2nd REACH OUT IF YOU HAVE ANY QUESTIONS. WE LOOK FORWARD TO SEEING YOU IN LESS THAN TWO WEEKS. >> THANK YOU ALL, IT'S BEEN AN HONOR TO BE PART OF THE TREASURY AND THE RELATIONSHIPS THAT ARE DEVELOPED AND THANK YOU. >> KEEP UP THE CHARGE. >> WE WILL MISS YOU. >> THANK YOU, LIZ. >> THANK YOU, EVERYBODY FOR ALL YOUR ENERGY AND TIME AND WE ARE ADJOURNED.